Monday, September 26, 2016

Why you Should See an Elder Law Attorney if You Need Long Term Care

Early in my career as an elder law attorney, I attended a talk given by the administrator of a local nursing home. This happened over 30 years ago, but I remember it well. Some events just stick in your mind. 
The subject of the talk was what you should expect when you enter a nursing home. At the end of the presentation, the administrator took questions. One audience member raised her hand and asked an important question – “what happens to my home when I run out of money to pay for my care? Will I have to turn it over to the nursing home?”
The administrator answered by saying that when you use up your savings, you have to sell your home to pay for your care. As a young attorney who had spent a lot of time studying the laws related to paying for nursing home care, I knew that the administrator’s answer was wrong. When you exhaust your ability to pay the full cost of the nursing home, Medicaid will step in and pay for your care. You don’t have to sell your home. Medicaid rules allow you to keep your home.
I also understood that it was to the nursing home’s advantage for people to sell their homes to pay for their care rather than go on Medicaid. That is because nursing homes charge residents who pay privately more than they can charge once the resident goes on Medicaid. So, to maximize its profits a nursing home will usually want to have as many “private pay” residents as possible.
The nursing home and its residents have a fundamental conflict of financial interest. Yet, most nursing home residents and their families rely on the nursing home for advice about payment rules and Medicaid. I felt it was important that seniors at the talk knew that the law protected their homes when they entered a nursing home, so I raised my hand.
When the administrator called on me I stood up and said that I thought that her answer to the question of what happens to your home when you run out of money was not entirely correct.  (I was trying to be tactful).  I said that the law provides that you can retain ownership of the property where you resided when you entered the nursing home and still be eligible for Medicaid assistance to pay the cost of your nursing home care. The administrator gave me one of those “looks that can kill” and moved on to the next question. After the meeting ended she came over to me and said, “Look Sonny, we are trying to run a business here. Don’t you be attending any more of my meetings!”
Fair enough. I did not attend any more of her meetings. But I did start setting up public presentations on my own so that I could explain the payment rules to seniors and their family members. I didn’t want people to have to rely solely on the information they got from the nursing home. And I’m proud to say that over the years I was been able to protect the homes of many residents of that administrator’s nursing home.
I have to be careful here because I think that these days most nursing home employees do try to do the right thing and provide people with as accurate information as they can. But nursing home administrators, admission directors, and business office managers are not lawyers – you can’t expect them to fully understand the laws that protect the home and other resources of their residents. In fact, some of the better nursing homes recognize this and recommend that their residents meet with an elder law attorney to discuss payment options and Medicaid rules.
But many families still try to "go it alone" with only the limited direction they get from the nursing home to guide them. They need to be aware of the nursing home’s conflict of interest: the longer a resident is in private pay status rather than on Medicaid, the more profit for the nursing home. Smart consumers don’t rely solely on the nursing home for information about paying the cost of care. They get advice about their rights and options from an expert elder law attorney who is working just for them.     
In 1985, when I attended the administrator’s talk, the average cost of a month in a nursing home was under $1,400.  Today the average cost in Pennsylvania has soared to over $9,000 a month.  Few families can afford to bear that kind of cost for long. Most long term nursing home residents eventually go on Medicaid. They need to know that their home is still protected: they can keep it by filing the right paperwork with the Medicaid office and getting Medicaid assistance to help pay for their care sooner rather than later.  
Unfortunately, the protection of your home is not quite as good as it was in 1985. In 1994 a new law called Medicaid Estate Recovery came into effect that can force the sale of your home after your death in order to reimburse Medicaid.
Estate Recovery applies if you get Medicaid funded long term care services in a nursing home. It also applies if you get Medicaid help with long term care at home through the Aging Waiver or LIFE programs. Pennsylvania’s Estate Recovery Department recovers tens of millions of dollars every year, mostly from the sale of homes, so this is a real concern.
There are ways to plan in advance to avoid Estate Recovery. If you want to protect your home for your family, planning with an expert elder law attorney is critically important.  The sooner you start that planning, the better your family’s chances.
If you or a family member needs long term care or may need it in the next five to seven years and resides in Pennsylvania, you can get up to date advice and guidance from the lawyers at Marshall, Parker and Weber. We will show you how to protect your home from loss to health related costs during your life and from Estate Recovery after your death.

Monday, September 19, 2016

Should I Wait to Get my Flu Shot?

I was planning to get my flu shot this week. I see the signs (advertisements) every time I visit the supermarket or drug store. About two weeks ago my wife received a mailer from Wegmans Pharmacy saying “It’s time to get your flu shot.”
So, I figured this must be the right time to get this annual ritual over with. Right?
But, Wait!  This weekend there was a piece on NPR’s Weekend Edition that suggests that “Older People Might Consider Waiting A Bit Longer ToGet Flu Shot.” It seems that immunologist Laura Haynes suggests people over 65 wait until Halloween to get their flu shots, to make sure the immunity lasts through the flu season.
According to Dr. Haynes, a professor of immunology with the University of Connecticut Center on Aging: “the best time for most people to get the flu vaccine would be in October. If you're a little bit older and over 65, I would say between Halloween and Thanksgiving.” The reason is that our older immune response wanes more quickly than when we were younger. So, we older adults may want to wait a little longer to get our shot so that we stay protected through the worst of the flu season (which happens from January to April).
Even though the flu vaccine will not necessarily keep you from getting sick, older adults should get the shot since it has been shown that it can keep us from getting sick enough to avoid having to go to a hospital. Flu is a serious disease responsible for many deaths each year, particularly among older adults and young children. So most seniors should be sure to get the shot. Later may be best, but early is better than never. Of course, checking with your doctor is a good idea, especially if you have any questions or concerns.
As with most things involving drugs, the evidence is uncertain and it's unclear how long the immunity imparted by the vaccine lasts for older adults. Still, the idea of waiting until we are closer to actual flu season makes a lot of sense to me.
So, my wife and I are going to delay getting our shots this year, and it’s not procrastination. Happy Halloween!
Here is a link to the NPR story and a related article from Julie Appleby of Kaiser Health News.

For a different point of view see: When should I get my flu shot?

Tuesday, August 16, 2016

PACE (LIFE) Program Regulations Being Updated

PACE is a Medicare and Medicaid funded program that provides comprehensive medical and social services to enable older adults to live in the community instead of a nursing home. Pennsylvania has been a national leader in promoting the PACE concept.
On a national level, the program is referred to as PACE (Program of All-inclusive Care for the Elderly). But that name was changed in Pennsylvania to avoid confusion with our state pharmaceutical assistance program. In Pennsylvania PACE programs are generally referred to as LIFE (Living Independently For Elders).
Despite being in existence for decades the PACE concept has been relatively slow to grow. Currently about 38,000 older adults are enrolled in 120 PACE organizations in 31 states. Legislators have been encouraging the Centers for Medicare & Medicaid Services (CMS) to update the program in order to increase the use of what is seen as more cost effective and desirable home based care. See Lawmakers Push for Sweeping Changes to PACE Program.  
Now, CMS is proposing a rule to update and modernize the PACE program. It is the first update in ten years. The rule was published today (August 16, 2016) in the Federal Register.
The proposed rule is intended to modernize the program, improve care to beneficiaries, and expand the program. In order to expand access to PACE, CMS is proposing a number flexibilities including allowing non-physician primary care practitioners to provide some services in the place of primary care physicians.
For more information on the PACE (LIFE) program in Pennsylvania see my prior article Frail older adults can stay at home with LIFE program’s help.
I have reproduced a list of the LIFE programs currently operating in Pennsylvania below. In you live in another state to find a PACE program near you visit the PACE Program Finder here.
Pennsylvania PACE (LIFE) programs:  
Albright LIFE Lancaster
417 W. Frederick St.
Lancaster, Pennsylvania
+1 717 381 4320
Albright LIFE Lebanon
113 S. Ninth Street
Lebanon, Pennsylvania
+1 717 376 1133
Albright LIFE Williamsport
901 Memorial Avenue
Williamsport, Pennsylvania
+1 570 322 5433
Community LIFE
2400 Ardmore Blvd.
Suite 700
Pittsburgh, Pennsylvania
+1 412 436 1320
Erie, Pennsylvania
LIFE - Pittsburgh
681 Andersen Drive
Pittsburgh, Pennsylvania
+1 412 388 8042
LIFE Beaver County
Aliquippa, Pennsylvania
+1 724 378 5400
LIFE Butler County
Butler, Pennsylvania
+1 724 287 5433
LIFE Geisinger - IHM Center
Scranton, Pennsylvania
+1 800 395 8759
LIFE Geisinger - Roosevelt Court Center
Kulpmont, Pennsylvania
+1 866 230 6465
LIFE Lawrence County
New Castle, Pennsylvania
+1 724 657 8800
LIFE Lutheran Services, Inc.
Chambersburg, Pennsylvania
+1 717 264 5433
LIFE St. Mary
Trevose, Pennsylvania
+1 267 991 7600
Mercy LIFE
Philadelphia, Pennsylvania
+1 215 339 4747
Mercy LIFE - West Philadelphia
Philadelphia, Pennsylvania
+1 215 573 7200
Mercy LIFE Sharon Hill
Sharon Hill, Pennsylvania
+1 215 339 4747
Mercy LIFE Valley View
Elwyn, Pennsylvania
+1 215 339 4747
NewCourtland LIFE
Philadelphia, Pennsylvania
+1 267 335 1500
PACE Armstrong County
115 Nolte Drive Extension
Kittanning, Pennsylvania
+1 724 545 8000
Senior LIFE Ebensburg
429 Manor Drive
Edensburg, Pennsylvania
+1 814 472 6060
Senior LIFE Johnstown
401 Broad St.
Johnstown, Pennsylvania
+1 877 998 5433
Senior LIFE Uniontown
89 West Fayette St.
Uniontown, Pennsylvania
+1 877 998 5433
Senior LIFE Washington
2114 North Franklin Drive
Washington, Pennsylvania
+1 877 998 5433
Senior LIFE York
1500 Memory Lane Ext.
York, Pennsylvania
+1 877 998 5433
SeniorLIFE Greensburg
123 Triangle Drive
Greensburg, Pennsylvania
+1 724 838 8300
SeniorLIFE Lehigh Valley
Bethlehem, Pennsylvania
+1 610 954 5433
SpiriTrust Luthern LIFE
840 Fifth Avenue
Chambersburg, Pennsylvania
+1 800 840 9081