Veterans: Are You Getting Older, Need Care, and Want to Stay at Home?

February 27, 2014

Filed under: Living at Home,Veterans Benefits — Alexis @ 11:10 AM

Good news! The VA has several programs designed to assist elderly and/or disabled veterans who want to stay at home for as long as possible. Listed below are some of these programs. They each have different eligibility tests regarding income and assets, minimum age, level of disability, service-connected rating, and geography. If you are interested in any specific program, talk to the outpatient social worker at the VA clinic that you use.

1. Three hours of home health aides per week.
2. Skilled care at home.
3. Adult Day Health – the VA has contracts with many local adult day health programs.
4. TeleHealth (a computer in your home permits a remote nurse to monitor basic health indicators on a daily basis).
5. Home-Based Primary Care. For the truly home-bound, veterans can receive home visits from a team consisting of the PCP, occupational therapist, physical therapist, social worker, and more.
6. Veterans Independence Plus Program (VIPP) provides a budget for a veteran to bring in the care he needs to stay at home, including home health aides, grocery delivery, snow shoveling, visiting nurses, etc.
7. Respite care, meaning that the caregiver can take a break while the veteran stays at the Brockton Community Living Center for 9, 16, 23, or 30 days.

These programs are available only to the veteran. If the spouse or widow of a veteran needs help staying at home, she should look into Aid & Attendance. If you would like further help exploring these programs or other resources to help you stay at home for as long as possible, please contact our office to schedule a Planning Session.

Aid & Attendance

February 20, 2014

Filed under: Living at Home,Veterans Benefits — Alexis @ 11:05 AM

Most of my clients need a little extra help around the house but aren’t sure how to pay for it. When we look at their savings and project how long those funds will work for them, the bottom line is usually this: If the client had just a little more cushion, they could stay at home with the proper supports for longer. But where can they find the money?

For many of the Greatest Generation, the answer lies in Veterans’ Benefits. There is a fantastic program that few seniors and their families know about: Aid & Attendance. Once you qualify, the VA will send a monthly check that you can use to pay caregivers, buy medical equipment, remodel a bathroom to be wheelchair accessible, pay rent at assisted living – whatever you decide is the best and most effective use of that money. This is the most logical, pragmatic long-term care program I know of. It helps seniors stay at home or in an assisted living residence – and out of a nursing home – for longer. All without limiting you to certain home health aide agencies, rolling deductibles, and a lot of the impediments that come with other support programs.

For 2014, the figures are as follows: If the veteran needs assistance, the maximum amount that he or she can receive is $1,759 per month. If the spouse is the one who needs help at home, he or she can receive up to $1,380 per month. A widow can receive at most $1,130 per month. If you both need care, you can receive up to $2,085 per month. These funds can help supplement home care, and they can also be very useful if you move to assisted living.

The application process for the A&A program is not for the faint of heart. There are reams of papers to fill out (of course), and it can take at least six months to receive approval. More to the point, the VA regulations are hard to find, and if you can find them, impossible to understand. More than almost any other government program, you will need an elder law attorney or a qualified veterans’ representative to walk you through the planning process. Without this help, it is very difficult to obtain the maximum benefits you are entitled to.

In order to assist you, an attorney must be “certified” by the VA and take requisite training. I have made it my business to become certified and receive the necessary education so that I can help my clients stay at home for longer.

If you would like to explore whether A&A can help you pay for your care, please call our office.

Beware of the Binding Arbitration Agreement in the Nursing Home Admission Packet

February 18, 2014

Filed under: Estate Planning,Financial,Health Care Facilities — Alexis @ 9:50 AM

Imagine that you’re being admitted into a nursing home.  You are having trouble making decisions and managing your affairs at this point.  Luckily, you planned ahead and have a Health Care Proxy in place.  Your agent fills out the reams of paper that seem necessary for your admission, including a binding Agreement to Arbitrate.  That means that if you ever have a dispute with the nursing home, you are agreeing in advance to use binding arbitration, and not a jury trial, to settle that dispute.  Your agent signs it, figuring you can’t be admitted without it.  All is well until a dispute arises and – boom – you’re stuck heading to arbitration.

While it may sound attractive, arbitration tends to favor the “big guys” – in this case, the nursing home and health care providers.  For you as the patient, or “little guy,” jury trials are far more consumer-friendly.

Good news, though – in January, the Massachusetts Supreme Judicial Court (our highest court) decided the Johnson case, which says that the decision to sign an arbitration agreement isn’t a health care decision.  And because the agent named in your Health Care Proxy can only make health care decisions on your behalf, if he or she signs an arbitration agreement, a court will find that agreement void.

But what if you have both a Health Care Proxy and Power of Attorney in place?  This difference is key because the agent named in your Power of Attorney CAN agree to binding arbitration on your behalf.  A Power of Attorney gives more business-related decision-making powers than a Health Care Proxy, so the agent named in your Power of Attorney can make financial and legal decisions on your behalf.  Agreeing to arbitration is not a medical decision but it is a legal one, so it’s one the agent named in your Power of Attorney CAN make.

As I mentioned, arbitration tends to favor the nursing home if a dispute arises.  But how can you protect yourself?  First, most nursing homes do NOT condition admittance on whether or not you (or your agent) agree in advance to arbitration.  Simply refuse to sign the arbitration agreement within the admission packet, or if it is part of a larger document, cross out those paragraphs.

Also, your Power of Attorney document should make it clear that your agent cannot agree to binding arbitration before a dispute arises.  When a dispute happens, arbitration may be your best option – but you don’t want to make that decision before you know the facts.

And if you don’t have a Health Care Proxy or Power of Attorney yet?  Put them in place now.  It won’t take much time at all.

Which Hospital Must an Ambulance Take You To – Can You Demand a Specific Hospital?

February 13, 2014

Filed under: Medical Care — Alexis @ 10:43 AM

The answer is – it depends.

If there is an emergency and you are unable to express your wishes, even if you have advanced medical directives or a health care proxy in place, the Emergency Medical Technicians or Paramedics responding to the call are obligated to stabilize you and transport you to the nearest appropriate hospital. This does not necessarily mean you’ll be transported the closest hospital – for example, if you are severely burned, the ambulance may bring you to the nearest hospital with a specialized burn unit, even if there are other hospitals closer by. Once you have been evaluated, your advanced health care directives can be implemented, including transporting you to another hospital if a transport can be done safely.

In a situation where you are able to express your wishes, an ambulance may take you to the specific hospital you demand. Some ambulances, especially town or municipal ones, may be assigned to a certain “zone,” and are unable to take you to a hospital outside of their assigned region. And, if a hospital’s emergency room is full and not accepting any more patients, an ambulance may not be able to bring you there, even if that is where you wish to go.

It is also important to note that Medicare only covers ambulance services “to the nearest appropriate medical facility that’s able to give you the care you need.” If you demand transportation and are brought to another hospital instead of a closer, equivalent facility, you could be left to foot the bill on your own. An ambulance crew cannot ask you about your insurance, but it is important to know that Medicare may not cover ambulance transport if you demand a specific hospital.

Heard at the Office: “I Don’t Need a Power of Attorney, My Spouse Can Manage My Finances for Me.”

February 6, 2014

Filed under: Estate Planning,Financial — Alexis @ 10:40 AM

That would be the simplest approach, but unfortunately, this is not the case. For any accounts that are joint with your spouse (usually bank accounts, like savings, checking, and CD’s), then yes, even if you are in the hospital or develop dementia, your spouse can manage those accounts.

But what about accounts that are in your name alone? Like your IRA and 401(k), for starters? And that Christmas account that you opened a few years ago, the one your spouse doesn’t even know about? If you are the only owner of an account, then you are the only one who can access those funds. Your spouse cannot help you with your accounts – unless you name him as an Agent under your Durable Power of Attorney (POA).

Only after you (1) name your spouse as an Agent in your Durable Power of Attorney and (2) contact your bank or financial institution to have him listed as a POA on the account, can your spouse then help you manage your accounts in the event you become hospitalized or otherwise unable to manage your finances.

If you develop dementia and have accounts in your name alone, and if your family needs to access those accounts for your care, then your family will be forced to go to court to establish a “Conservatorship” over you. That costs a lot of money (your money, by the way), and takes a lot of time and emotional energy.

Moral of the story? Put a Power of Attorney in place now. It doesn’t take much time at all.