Useful Info During COVID v.4

May 12, 2020

Dear Friends,

This is our fourth newsletter during these interesting COVID times.  It’s funny – my writing bug tends to come in waves and then go away for a while.  Apparently it’s been sticking around lately.  I’m sure you can relate when it comes to your writing, art, or hobbies.  This week I want to focus on what our office can do for you, right now.  You can revisit our prior newsletters here.

Get Your House in Order a/k/a Get Your Ducks in a Row

If you have time on your hands right now, maybe it’s a good moment to spend a few hours working out the what / who / how of your estate plan.  I can help you make sure that those who matter most know what matters most to you in terms of your health care.  We can think through and plan for how to make sure that you get the hands-on care you might need over the years.  We can figure out what the best vehicle is for you to create an inheritance process for your heirs.  We can talk through who the best people are to be your health care proxy, power of attorney, executor, and trustee.  We can wrestle with and work through the various components of getting your house in order (or, if you are sick of being at home – we can call it getting your ducks in a row).

Billing & Discharge Issues from the Hospital, Rehab, or Nursing Home

For anyone on Medicare (plus a supplement, or, on a Medicare Advantage Plan), you need to know that Medicare has strict billing requirements.  If the hospital, rehab, or nursing home bills incorrectly to Medicare and the supplemental insurance, the provider will be in trouble.  Not only will they not be paid for the particular service that they incorrectly billed for, but they may even owe a penalty.  If you are having billing problems with a provider, you need to understand this.  And, it gets tougher – during this state of emergency, CMS (the federal agency housing Medicare) has changed MANY of their billing and service requirements.  It is very understandable that some medical billing offices could be confused, receiving conflicting guidance, etc.  If you are having billing problems, first, be patient with the person on the other end of the phone, and second, feel free to call me for help.

MassHealth Applications

If you find out that your loved one needs to stay in a nursing home and you are worried about how to pay for that, please reach out and we can analyze whether it may be appropriate to apply for MassHealth.  If it is, then Doreen and I can handle the application for you.  Or, if the situation is sufficiently straightforward, I can give you some advice and then you can handle the application on your own.

Guardianship & Conservatorship

If your loved one has lost cognitive capacity and does not have an acceptable health care proxy or durable power of attorney, then you might need the probate court to appoint a guardian (to make health care decisions) and/or a conservator (to handle finances and real estate).  If you need this, you have two options: If a hospital or nursing home is telling you that you need a guardianship and/or conservatorship, they may have their attorney handle it, for free.  If that’s the case, just make sure that the attorney is naming someone that the family agrees would be a good choice.  If the free work is not an option for you, then call me and I can handle the guardianship and/or conservatorship for you.  (Pro tip: Don’t ever put your family in this position – instead get your ducks in a row now and sign a health care proxy and power of attorney!)

Stimulus Checks to the Deceased

Some of you have received stimulus checks made out to persons no longer living.  Turns out, you need to send those back.  If you still have the check, you can mail it to the IRS.  If you cashed it or received it by direct deposit, you will need to write out a check to mail to the IRS.  Here are the (very clear) directions from the IRS on how and where to mail it (see Q41).

Pick the Lawyer’s Brain

Go bold or go home.  Oh wait, I’m already working from home.  In any event, I’m trying something new: a Zoom call to ask me anything related to elder law, special needs planning, veterans benefits, or estate planning.  Let’s try this and see how it goes!  Thursday, May 14 from 2:00 – 2:30.  Limited to 15 people.  Reply to this newsletter, or email Doreen (doreen@alexislevitt.com), and we will send you the login information.

Also I am converting a playhouse into a chicken coop, so I am happy to receive any and all chicken coop construction advice!

Be good to yourself and each other, and get outside to enjoy this glorious spring.

– Alexis & Doreen

Useful Info During COVID v.3

May 11, 2020

Dear Friends,

This is our third newsletter during these interesting COVID times.  This one shares useful info, plus something beautiful.  You can revisit our prior newsletters here.

Share Your Care Wishes with the People Who Matter Most:

None of us knows when our health will take a turn.  The best gift you can give yourself and to the people who matter most is to think through and then share what matters most to you.  Your health care proxy can do the best possible job only if she or he knows what kind of care you want and don’t want.  An EXCELLENT springboard for thinking through, documenting, and sharing what matters most with the people who matter most comes from the Conversation Project.  Visit their site for an excellent worksheet.  While you are there, check out all the other resources on their website.

Excellent Community Resources

The Alzheimer’s Association 24/7 Helpline is open.  If you are feeling at the end of your rope, or even if you are well before that point, call them.  They can help.

Remember that your local Council on Aging is a bastion of information and resources!  If you need anything, call them and they will either solve your problem or refer you to someone who can.  Yes, your local senior is open for phone calls!  (But not walk-ins.)

Technical Stuff:

If you have medical billing issues related to Medicare, check out this amazing guide from the Center for Medicare Advocacy.  It’s technical, but readable.  There have been a LOT of changes to Medicare billing and requirements in light of COVID-19.  This guide provides excellent summaries of many of them.

A Reminder (Third Time – We are Serious about This Point!):

Keep your Health Care Proxy, HIPAA Statement, and medication list at your fingertips. 

(a) If you are a client of ours, then we enrolled you in DocuBank.  Take five minutes now to update your medication list.  (Really.  Five minutes.  I updated mine recently, it was very easy.)

(b) Keep copies on your phone.  You can save the documents to your Google Drive, you can simply keep them attached to an email, whatever you like, so long as they are accessible to you on your phone.  If you would like us to email PDFs of your signed documents to you, or to someone important to you, please call us or email us (doreen@alexislevitt.com).

(c) Keep copies on the back of your front door or on your refrigerator.  Many first responders will look in these places for emergency medical papers.

(d) If you do not have a health care proxy, download one today from Honoring ChoicesYou will need to witnesses – perhaps your neighbors can watch you sign through your glass door or window.

Something Beautiful:

Have you seen the Stephen Sondheim 90th birthday party?  It is so beautiful.  (Pro tip: It’s easy to skip around if you don’t like a particular song.)  Be sure to watch the closing remarks and final song – you just may cry from the beauty in this world.

And Remember:

Our office is open.  We are working from home, but if you need anything at all, just call or email, and we will get right back to you.

We had our first outdoor signing last week, and it was actually a bit of a party, since the Xfinity truck yard next door was playing some loud music!  We can also do video signings now, thanks to a bill that the governor signed this week.  We did our first one today.  It’s certainly been a period of firsts for a lot of things.

Hang in there, and get outside for plenty of fresh air and sunshine.  And wash your hands!!

– Alexis & Doreen

Our first outdoor signing!  That’s Doreen, Rich (Alexis’ spouse, pinch-hitting as a witness), and Alexis.  Photo used with clients’ permission.


E-Newsletter: Useful Info During COVID

April 2, 2020

Following is the text of our recent e-newsletter. If you would like us to add you to our e-newsletter mailing list, please visit our homepage.

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Dear Friends,

This is our second newsletter during these interesting COVID times. The first newsletter offered legal information. This one shares useful info, plus something beautiful. You can revisit our first newsletter here.

We begin with a reminder:

Keep your Health Care Proxy, HIPAA Statement, and medication list at your fingertips.

(a) If you are a client of ours, then we enrolled you in DocuBank. Take five minutes now to update your medication list. (Really. Five minutes. I updated mine recently, it was very easy.)

(b) Keep copies on your phone. You can save the documents to your Google Drive, you can simply keep them attached to an email, whatever you like, so long as they are accessible to you on your phone. If you would like us to email PDFs of your signed documents to you, or to someone important to you, please call us or email us (doreen@alexislevitt.com).

(c) Keep copies on the back of your front door or on your refrigerator. Many first responders will look in these places for emergency medical papers.

(d) If you do not have a health care proxy, download one today from Honoring Choices. You will need to witnesses – perhaps your neighbors can watch you sign through your glass door or window.

We move on to community offerings:

The Wonder Duo of Two Sisters Senior Living Advisors, Michelle and Alyson, are bringing you free, professional chair yoga every Tuesday and Thursday morning! More info here (scroll down the page). Mark your calendars!

The Alzheimer’s Association 24/7 Helpline is open. If you are feeling at the end of your rope, or even if you are well before that point, call them. They can help.

The Alzheimer’s Association is also hosting a slew of webinars online. They have even found a way to continue with their support groups. Check it out. There is no need to go this alone.

Remember that your local Council on Aging is a bastion of information and resources! If you need anything, call them and they will either solve your problem or refer you to someone who can. Yes, your local senior is open for phone calls! (But not walk-ins.)

Now for Community Requests:

South Shore Hospital is requesting the following:
Financial donations
Homemade masks (attention people who love to sew!)
Supplies so that the hospital can make their own masks
Gift cards for employees in need
N95 masks, gowns, goggles, other PPE

Norwell VNA & Hospice is requesting N95 masks, gowns, goggles, and other PPE.

And, Something Beautiful:

There is a national movement to plaster our neighborhoods with hearts, in support of our health care workers who are on the front lines. In our neighborhood, teacher Kathleen Malone and her kids took the lead, and now we all have lovely homemade hearts on our doors. The ones with the Red Cross symbols were given to the nurses in our neighborhood, and they have told us that this makes them feel supported and loved. Pull out some art supplies and bring the same to your street!

   

And Remember:

Our office is open. We are working from home, but if you need anything at all, just call or email, and we will get right back to you.

Hang in there, and get outside for plenty of fresh air and sunshine. And wash your hands!!

– Alexis & Doreen

E-Newsletter: If You Are Hospitalized During the State of Emergency

March 30, 2020

Following is the text of our recent e-newsletter.  If you would like us to add you to our e-newsletter mailing list, please visit our homepage.

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Dear Friends,

I hope you are all staying home (unless you are an essential worker).  I want to share some important points to keep in mind if you are hospitalized during the state of emergency.  These apply whether you are hospitalized for COVID-19 specifically, or for any other reason.

1. Keep your Health Care Proxy, HIPAA Statement, and medication list at your fingertips. 

(a) If you are a client of ours, then we enrolled you in DocuBank.  Take five minutes now to update your medication list.  (Really.  Five minutes.  I updated mine recently, it was very easy.)

(b) Keep copies on your phone.  You can save the documents to your Google Drive, you can simply keep them attached to an email, whatever you like, so long as they are accessible to you on your phone.  If you would like us to email PDFs of your signed documents to you, or to someone important to you, please call us or email us (doreen@alexislevitt.com).

(c) Keep copies on the back of your front door or on your refrigerator.  Many first responders will look in these places for emergency medical papers.

2. Advocate to be coded as “inpatient” rather than “under observation.”  If you are in the hospital and then transferred to a rehab, how you were coded at the hospital will make a big difference in payment source for the rehab stay.

3. If you are transferred to rehab and told that you will be paying privately, call us.  Under the State of Emergency, some of the usual coverage triggers for payment for rehab have changed.  Nursing home billing offices could be – quite understandably – overwhelmed and perhaps not updated on the temporary changes.  We can help.

4. Call us if you need a guardianship or conservatorship.  For anyone who has not signed a health care proxy or a power of attorney, the hospital (or rehab) may tell you that you need a guardian or conservator.  This is a court proceeding handled by an attorney.

(a) It’s possible that the hospital or rehab attorney will handle the guardianship and/or conservatorship for you, for free.  If that is the case, be sure to check in with them as to who they are naming to act as the guardian or conservator, and, if you are not happy with their choice, advocate for naming someone you prefer.

(b) If the hospital or rehab tells you that you need to find your own attorney (or if you are not comfortable using their attorney), then please call our office.  This is something that we can handle for you.

5. Our office is open.  We are working from home, but if you need anything at all, just call or email, and we will get right back to you.

Hang in there, and get outside for plenty of fresh air and sunshine.

– Alexis & Doreen

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.

Looking at Continuing Care Retirement Communities? Look Closely.

December 3, 2010

There are a lot of benefits to Continuing Care Retirement Communities (CCRC’s), also called “Buy-In’s.” These are the places where you put down a substantial sum (maybe $250,000 or more) as an entrance fee, and you plan to stay there for life – they have independent apartments, various levels of assisted living, and skilled nursing (nursing home), all on campus. There is definitely something appealing about the promise of being cared for for life.

But will they really care for you for life? There are some big questions right now about the nursing home units at CCRC’s. For example, when describing the nursing home to you, a potential customer, the sales staff will explain that if you run out of money, they will help you apply for Medicaid. Well, as it turns out, sometimes the CCRC makes you spend down even further than the Medicaid rules do.

For example, for a married couple, if one spouse needs nursing home but the other is still in the community (ex. in her own apartment or in the assisted living), MassHealth rules permit the community spouse to keep about $110,000 to live on. But guess what – before letting the husband move into a MassHealth nursing home bed, the CCRC might make the wife spend her own money down even further than the $110,000, maybe allowing her to keep only $50,000 for herself. And what did they have her spend it on? The husband’s private pay bed in the CCRC nursing home. And how much longer can she last in the community with only $50,000 to her name?

The sales team might also tell you that if a couple really runs out of money, there is a benevolent fund that will help you pay your monthly fees. I’d be a lot more comfortable moving into a CCRC if I saw the balance sheet for that benevolent fund – is there really enough in it for all the residents who might need help? And do they ever really expend from the benevolent fund?

Before committing to a CCRC, do your research. Dig around to make sure that what the sales staff is telling you is true. Two sources of hands-on experience with the nursing home units are going to be (1) local families who have been through the nursing home, and (2) local elder law attorneys who have helped clients navigate the CCRC nursing home experience.

Newton Health Care Center

December 4, 2008

Filed under: Health Care Facilities — Tags: , , , — Alexis @ 2:53 PM

On a beautiful December Wednesday, I drove to Newton to tour the Newton Health Care Center.  The owner, Healthbridge, also has the Weymouth Health Care Center on the South Shore.  From the outside, it looks like an old-fashioned, brick nondescript nursing home, but inside, there is a lot going on.  They offer an Alzheimer’s care unit, long-term care, short-term rehab, and post acute care.  

Most interesting, though, is their “orthopedic unit.”  This is a 22-bed wing designed for people who need a short stay while recovering from hip replacements, knee replacements, or other orthopedic surgeries.  It is such a change to see a unit built for baby-boomers – rooms are private, each has a flat screen TV, there is internet access, and the wing is spacious and tastefully decorated.  Very different from the usual institutional experience!

Through all the units, I noticed a few things that I liked.  One was sunlight – lots of it.  Plenty of natural light is key to mood and health.  Despite being right off the highway, there were also peaceful views out many of the windows, whether of trees or a neighboring gold course.  Again, soothing, natural sights help life mood and promote health.  The courtyard used by the Alzheimer’s and dementia residents is larger than at many other facilities.  And the two things I also look for when visiting facilities – the staff looked happy and calm, as did the residents.