Do you have a loved one currently living under the care of a nursing home facility? If this is the case, establishing the best possible care for them is obviously top priority. Elder Law and Nursing Home Attorneys help keep these plans in place while ensuring all parties involved are following all federal laws. These laws and attorneys also establish protection for your loved one during the event that something inappropriate or dangerous occurs.

I mention federal law specifically because, in situations where federal funding is provided to the nursing home facility, these laws must be followed. The federal law outlines minimum requirements in terms of staffing, caring for guests and how the facility is maintained. There are additional conditions for nursing home facilities involved with programs such as Medicaid and Medicare.

What can we do if these laws are not followed?

I’ve heard of a situation where a grandmother was poorly taken care of in a nursing home where her primary care physician referred to the family. The family trusted this physician’s recommendation, and did not perform any background checking on the facility or any of its staff members. Later on, one of the adult grandchildren realized she wasn’t being fed humanely (staff workers were mixing up the entire meal into one bowl and feeding it to her thinking she wouldn’t know any better).

What grounds did the adult grandchild have regarding nursing home law?

There are a number of options to consider, but don’t wait. Contact an Elder Law Lawyer, and a Nursing Home Lawyer (or Nursing Home Attorney, depending on how it’s named in your locale). Nursing home expenses are high as it is, and because of these costs you want to ensure no laws are being broken. This is your right, and you have protection for your loved ones in the nursing home facility.

If, once involving a lawyer and taking all the necessary steps involved, you are still unable to reach a resolution, make attempts to find another facility or location for your loved one to receive care. If you or a family member is able to take care of your loved during the interim, consider doing so in order to remove them from the premises as soon as possible. Why subject them to continued discomfort if unnecessary? If this isn’t possible, though (and it could be for a number of valid reasons), research a suitable transfer to another nursing home facility.

Robert J. Kulas, P.A. Attorneys at Law is a member of the American Academy of Estate Planning Attorneys.

Making plans to go into a nursing home is not on the top of many people’s list of fun activities, however it is a necessity to think through the options. In this day and age, nursing home care can become a very expensive proposition if you have not planned properly earlier in life. The time to plan for nursing home care is when you are still in good enough health to research the options and understand the costs. Nursing home expenses can be shocking if you have never looked into the details of long-term care.

Medicare is a potential option for people who need nursing home care, but only under limited conditions. Medicare will pay a portion of nursing home costs for Medicare beneficiaries who need rehabilitation services or skilled nursing. In order to be covered, you have to receive services from a Medicare certified skilled nursing home only after qualifying with a hospital stay. That means that you have to be in the hospital for a certain period of time before entering the nursing home. Currently, that is for at least three days.

Another government program that can be of assistance is Medicaid. This is a state and federal program that will pay for most nursing home costs for individuals who have limited assets and income. The eligibility does vary from state to state, and Medicaid will only pay for care in a facility that is certified by the government to provide the services to Medicaid recipients.

In the end, you really don’t want the government in control of your nursing home care. Instead, it makes sense to plan your estate in such a way as to cover the expenses using long-term care insurance or your own personal resources. That is why you should work with an estate planning attorney early on to develop a plan that will allow you to have control over your care in those later years. Leaving things to chance is not a good plan as you may end up living in a place that is not a good choice for you simply because you cannot afford to stay anywhere else.

Robert J. Kulas, P.A. Attorneys at Law is a member of the American Academy of Estate Planning Attorneys.

Every year, Genworth Financial conducts a nationwide survey of long-term care costs. The report detailing the results of the2011 survey has been released and, to no one’s surprise, the cost of care in nursing homes and assisted living facilities has increased.

The Nationwide Trend

In fact, the cost of long-term care has shown a steady increase, on a nationwide basis, since 2005. When you look at the U.S. as a whole, nursing home fees jumped 5.1% from last year to this year.

What About Florida?

Here in Florida, the median annual cost for a private room in a nursing home is - $83,950, to be exact. A one-bedroom space in an assisted living facility will set you back $31,950, on average.

What’s Your Plan?

With long-term care costs high and rising, it’s smart to plan ahead for the possibility that you’ll one day find yourself in a nursing home or an assisted living facility.  The main options for paying for care are:

• To pay out-of-pocket, or with funds provided by family members
• To buy a good long-term care insurance policy
• To qualify for Medicaid

What’s the best option for you? An elder law attorney can help you assess your situation and make that determination.

Robert J. Kulas, P.A. Attorneys at Law is a member of the American Academy of Estate Planning Attorneys.

Having an incapacity plan is vitally important. You never know when catastrophe may strike, and even the youngest and healthiest among us are vulnerable to illness and accidents.

Incapacity Planning is Critical

That’s why it’s critical to plan in advance. With an incapacity plan, you use a living trust and/or other legal documents, called advance directives, to help ensure your wishes are honored if you reach a point at which you can no longer care for yourself. You appoint people of your choosing to take over your financial and medical decision-making, and you let your doctors know your preferences for end-of-life care.

What About Medicaid Planning?

What would happen if you became disabled and needed nursing home care? Unless you already meet the strict financial requirements for Medicaid eligibility, the cost of your care would come out of your pocket. And nursing homes are expensive – paying for care can deplete the life savings of all but the wealthiest among us.

You Need “Medicaid Triggers”

This is why many people choose Medicaid planning to position themselves to receive benefits. But if you’re disabled, you can’t plan for yourself; and your disability plan might not permit your agent to engage in Medicaid planning on your behalf. Unless your plan has “Medicaid triggers,” language that complies with Medicaid rules and specifically permits your agent to do Medicaid planning, your disability could mean a dead end when it comes to qualifying for Medicaid.

To find out if your incapacity plan includes “Medicaid triggers” – or to put a plan in place – contact a qualified estate planning attorney.

Robert J. Kulas, P.A. Attorneys at Law is a member of the American Academy of Estate Planning Attorneys.

The Medicaid program is a need-based program that is jointly administered by the federal and state governments, and many senior citizens use it as a means for paying for nursing home care. Because the program is jointly administered, Medicaid rules and guidelines can vary from state to state. In Florida, certain costs of care provided by Medicaid during a recipient’s lifetime are subject to a recovery program. How does it work?

When a Medicaid recipient passes away, the Medicaid program becomes a creditor of his or her estate. The amount of Medicaid’s claim is equal to the amount paid on behalf of the recipient for services rendered after that person reached age 55. 

Not all recipients are subject to recovery, though. If you are a Florida Medicaid recipient and you pass away leaving behind a spouse, a minor child, or a child who is blind or totally and permanently disabled – or if you pass away before reaching age 55 – then the Medicaid program will not file a claim against your estate.  Also, if you own a home that passes to close relatives and is determined to be a homestead protected from your creditors, then the house would not need to be sold to pay back your Medicaid claim.

As with most government programs, there are many more rules that apply to Medicaid recovery in Florida. To find out how Medicaid recovery rules might affect you and your family, you should speak to a qualified estate planning attorney.

Robert J. Kulas, P.A. Attorneys at Law is a member of the American Academy of Estate Planning Attorneys.

One misconception many people have is the idea that, if they need to go into a nursing home, Medicare will cover those expenses. This is only partially true. Medicare provides some coverage for nursing home care, but that coverage is very limited.

If you have Medicare Part A coverage, you’ll be entitled to in-patient skilled nursing care, but only if you’ve been hospitalized for at least three days first. And your coverage is capped at 100 days. Of these 100 days, the total cost of your care is covered only for the first 20. For days 21-100, Medicare will pay 80% of your bill.

If you need care for longer than this period of time – a reality for many people – you’ll have to find other ways to pay for your care. The common options are:

1. Use long-term care insurance to cover your expenses, assuming you’ve purchased and maintained a policy.
2. Pay for your care out-of-pocket, using savings or the assistance of loved ones.
3. If you qualify for Medicaid, this program will pick up much of the tab for your care.

If you fail to plan for your long-term care needs, you could find yourself in a bind. Long-term care insurance may be a good option, depending on your finances and certain other factors, but it needs to be purchased well ahead of time. Paying nursing home costs completely out-of-pocket is an option that only a few of us have.

And this leaves Medicaid as the many peoples’ best choice for nursing home coverage. However, since Medicaid is a need-based program, you’ll have to be below certain thresholds when it comes to income and assets before you can qualify. Simply giving away your property at the last minute in an attempt to qualify is not an option – this can disqualify you from receiving Medicaid benefits for an extended period of time. There are steps you can take that may help you qualify for benefits, but those steps have to be in compliance with very specific rules.

The best way to make sure that your nursing home costs will be taken care of is to start planning far in advance. Your estate planning attorney is a good source of information about the pros and cons of purchasing long-term care insurance, as well as the specifics of Medicaid planning.

Robert J. Kulas, P.A. Attorneys at Law is a member of the American Academy of Estate Planning Attorneys.

Did you know that, if you meet the Medicare age requirements and your income and assets are low enough to qualify you for Medicaid, you can receive benefits from both programs at the same time? If you need long-term care, such as a nursing home or an assisted living facility, this could be especially helpful. Why?

Although Medicare offers coverage for certain medical costs, it offers only very limited coverage for long-term care. Medicaid, on the other hand, offers substantially more long-term care coverage. So, if you qualify for both, the two programs can work together to cover as much of your care as possible. Here’s how it works:

• Medicaid helps pay for the costs of living associated with long-term care. So, the basic living expenses you incur when you move into a nursing home or assisted living facility can be taken care of, at least in part, by Medicaid.
• Medical expenses that go above and beyond your living expenses are covered, at least in part, by Medicare.
• Plus, when it comes to these medical expenses, Medicaid can pick up where Medicare leaves off. Medicaid helps pay not only for procedures and medications not covered by Medicare, it also helps pay for Medicare premiums and deductibles.

One common myth about Medicaid is that, in order to receive it, you have to be completely destitute. While it’s true that there are strict income and asset limits, with careful planning, you can qualify for Medicaid while preserving property for your loved ones.

Robert J. Kulas, P.A. Attorneys at Law is a member of the American Academy of Estate Planning Attorneys.

As a loved one progresses from the early to the middle stages of Alzheimer’s disease, there may come a time when he or she needs more help than you can provide at home. Fortunately, there’s a variety of long-term care facilities available, ranging from assisted living facilities to nursing homes. The trick is choosing the right one for your loved one. With that in mind, here are some things to consider:

• What is the skill and experience level of the staff? You’ll want to look for a facility where the staff members are trained in dealing with those in all stages of Alzheimer’s. And you’ll want to make sure that, in addition to training, the staff members have actual experience dealing with Alzheimer’s patients. The first step is to simply ask the facility about the skill and training of its staff members. But, it’s essential to go beyond this, and visit the facility several times – preferably at different times of day.

Pay attention to the way the staff members interact with residents. Is their tone helpful and respectful, or harsh and condescending? How do caregivers respond to outbursts or difficult situations? Do the residents seem relaxed and happy, or is the overall tone of the facility tense?

• Is the facility close to friends and family? It’s ideal for your loved one to have plenty of friends and family visiting on a regular basis. If possible, you’ll want to make sure that the facility is close enough to friends and family that this can happen. When you visit the facility, pay attention to the way that visitors are treated. You’ll want to look for a facility with an open, welcoming attitude.

Does the facility cater only to Alzheimer’s patients, or to a variety of residents? There are advantages to each arrangement. Many facilities that cater only to Alzheimer’s patients have staff with a higher level of training and experience when it comes to dealing with residents. Also, the overall focus of the facility is likely to be geared toward anticipating and meeting the needs of those with Alzheimer’s. And, monitoring and security may be a higher priority than in other facilities.

On the other hand, a facility with a variety of residents can be a great place, socially, for seniors in all but the late stages of the disease. And, many of these facilities have staff members who are experienced in caring for those with Alzheimer’s. In these facilities, you’ll want to pay special attention to monitoring practices.

• What is the floor plan of the facility? Put yourself in your loved one’s shoes, and assess how easy – or difficult – it would be for someone to navigate the facility. If there’s a complicated layout featuring lots of intersecting hallways and dead ends, it may not be the best place for your loved one.

Robert J. Kulas, P.A. Attorneys at Law is a member of the American Academy of Estate Planning Attorneys.

Caring for an aging parent can be a stressful job, even if your mom or dad isn’t that demanding. You’ve got your household to run, a career to manage, and if you’re part of the sandwich generation, you’re still raising children of your own. Here are a few tips for relieving the stress:

1. Take Care of Yourself: This includes getting enough sleep (or at least trying to), getting regular exercise, and eating properly. If looking out for your health is not motivation enough, think about what would happen to loved ones if you weren’t there to take care of them.
2. Journal: Keeping a journal or diary serves two purposes – it helps you relieve stress by getting your day-to-day emotions and stresses down on paper, and it helps you get a clear picture of your parent’s day to day challenges. This way, you can track health changes as they’re happening, and let the doctor know as soon as possible.
3. Get Your Affairs in Order: Just like when your kids were little, you need to make sure your estate plan is solid, and there are provisions in place for who would take care of your mom or dad if something happened to you.
4. Keep up With Your Outside Interests: Make sure you’re still pursuing your own hobbies and interests. If you don’t have any hobbies, consider finding one. Having interests apart from your care giving duties – even if you can only spare an hour per week – will refresh you and make you a better caregiver.
5. Get Outside Help: No one can do it all alone. Look into adult daycare or home care for your mom or dad. And every once in a while, have a respite care worker come in, so that you can have a weekend away.

Robert J. Kulas, P.A. Attorneys at Law is a member of the American Academy of Estate Planning Attorneys.

Medicaid is a government program with complicated and ever-changing rules, especially when it comes to paying for long-term care. Here are some things you might not know:

• Medicare won’t pay for most long-term care. Medicare pays for only a small portion of nursing home stays, or other long-term care. Unless you have long-term care insurance, or you’re prepared to pay for your care out-of-pocket, you’ll need to learn about Medicaid planning.
• Transferring your property into your spouse’s name won’t help you qualify for Medicaid. In determining your eligibility for Medicaid, both your assets and your spouse’s assets are considered. There are methods you can use to plan for Medicaid, but transferring your property into your spouse’s name is useless.
• Your Power of Attorney probably doesn’t provide for Medicaid planning. There are very specific provisions involving gifting that have to be included in a general power of attorney in order for your agent to have the authority to do Medicaid planning on your behalf. Unless your power of attorney was drafted specifically with Medicaid planning in mind, it will likely be useless for that purpose once you become incapacitated. This is just one reason for you to start planning ahead of time.
• You don’t have to give away all of your assets to qualify for Medicaid. Medicaid has specific rules as to which assets you’re allowed to keep and still qualify for benefits. Plus, simply giving away assets can keep you from receiving benefits for a period of several years. Before you do anything to try to qualify for Medicaid, it’s important that you consult with a qualified Estate Planning attorney.

Robert J. Kulas, P.A. Attorneys at Law is a member of the American Academy of Estate Planning Attorneys.