LEGAL AND FINANCIAL ISSUES FACING THE CAREGIVER

LEGAL AND FINANCIAL ISSUES FACING THE CAREGIVER

Doctor Amy and the Caregiver Wellness Initiative have partnered with Daniel R. Flebotte, PLLC to provide free initial consultations concerning legal issues facing the Caregiver. Please use the contact number below to arrange for your free initial consultation or email your inquiry to Jill Flebotte and your call or your email inquiry will be directed to the appropriate person.
Contact Number for Daniel R. Flebotte: 919-724-6536
Direct email for Daniel Flebotte: dflebotte@gmail.com
Direct email to Intake Processor Jill Flebotte: jillflebotte@gmail.com

Legal

When you become a caregiver, you may have to deal with complex legal matters, such as powers of attorney, healthcare proxies, issues with residential facilities, guardianships or a variety of other matters. Outlined below are some frequently asked questions which can guide you in your decision making process.

What is elder law?

Elder law began to develop as a practice focus in the early 1980s. Recognizing that their practices focused on similar topics, most of which did not fit well into commonly recognized practice areas, a number of individuals from different states began to meet regularly to discuss the emerging practice area.

A common observation among these practitioners was that their clients were predominantly older, or were the children of older parents seeking assistance with the elders’ legal problems. From this observation grew the use of the term “elder law,” even though innovators realized that the term was imprecise. Many of the common legal problems of the elderly are shared by younger clients who may be disabled, or poor enough to qualify for government assistance despite their age. Still, most elder law clients tend to be older, and many elders share similar legal problems. They are frequently assisted by a family member or what the industry calls a lay caregiver.

Today, elder law is much better recognized as a distinct area of practice. Usually elder law attorneys focus their practices in a handful of areas. Those focus areas typically include long-term care planning, guardianship and conservatorship, advance medical directives, and the more traditional trust and estate planning. Other elder law attorneys spend considerable time dealing with Medicare, Medicaid and other government benefits, abuse, neglect, and exploitation issues; age discrimination, charitable giving; probate administration; and a host of other practice areas.

Although not necessarily an “elder” issue, one other topic that has become important in many elder law practices in recent years is planning for children or others with disabilities. This has opened up a related practice area in special needs planning. At the same time, planning for public assistance benefits for younger individuals with disabilities has grown more urgent and complicated. The entire area of special needs trust planning has become a significant focus of many caregivers wanting to protect family assets. Lay or family caregivers are also integrally involved in these legal relationships.

Of course elderly individuals can have any sort of legal problem and a practice devoted to serving the elderly is likely to be quite diverse. Most elder law attorneys, however, find that they concentrate their practices in a few substantive areas or even in one area alone.

How are elder law clients different from other clients?

Because elder law attorneys primarily serve the elderly and disabled, their clients will obviously be older than the clients of most general practitioners. Some of their clients are, however, younger family members concerned about a parent’s legal problems (or the problems of another elderly relative or friend). In addition, many legal problems commonly encountered by the elderly are also concerns for the disabled (for problems such as long-term care and advance medical directives) or minors (in conservatorships of the estate). As a result of these factors it cannot truly be said that all elder law attorneys’ clients are elderly, many of them are young. They are family members helping one another. Elder law clients may present with a single legal problem, not realizing that multiple issues are actually involved. For example, a client may request assistance with estate planning without realizing he or she should be considering the need for long-term care insurance or the need to plan for eligibility for public assistance with long-term care. Conversely, a client may request information about the availability of public assistance with the long-term care of a spouse without realizing that the spouse’s illness requires rethinking of the client’s own estate planning. Similar multiple-issue circumstances might occur for children planning for their parents’ long-term care, or parents seeking information about care of children with disabilities.

Are there generalizations that can safely be made about the characteristics of elder law clients?

Many caregivers are spouses, and will also be elderly. However, that is not universally true. Some caregivers are children of the elderly. Also, many caregivers are supporting children with special needs.

Younger caregivers, children for example, may fall into one of two broadly drawn groups: individuals with significant disabilities and the children of (or grandchildren of, or others connected with) older individuals. These two groups may be even harder to generalize about than older care recipients, but they may distinguish themselves in some regard by not being older. They may be more familiar with and prepared to utilize the benefits of the public assistance system. They may have a stranger sense of entitlement than their older colleagues. They will sometimes (but by no means always) be better educated than their elders. And they will almost certainly be more comfortable with accessing the internet to find information (and counsel), not to mention being more comfortable with email as one, or even the best, method communication.

What sorts of legal issues regularly arise in an elder law practice?

1. Long-term care planning, including advice regarding long-term care
insurance and the availability of Medicaid, and providing assistance
with applications for Medicaid and related benefits;

2. Guardianship of the person and conservatorship of the estate;

3. Estate planning and related real estate issues, including tax planning,
conveyancing, probate, avoidance, and advice concerning reverse
mortgage and other debt instruments;

4. Probate (or other procedures required on a person’s death) including will
contests, and questions relating to the administration of trusts;

5. Planning and implementation of “living Wills” and other advance
directives and health care rights;

6. Caring (and providing) for children or individuals with disabilities, including
planning, drafting and administering special needs trusts;

7. Access to Social Security, Medicare, and health benefits or insurance; and

8. Nursing home rights and procedures, including discharges from nursing home
care , quality of care, patient’s rights to privacy and association, and similar
problems.

What other legal resources are available online for the caregiver?

With a minimum of computer literacy, the interested caregiver can locate a wealth of information online. Websites with a focus on elder law have sprung up, such as law professor Kim Dayton’s “Elder Law Prof Blog” (http://lawprofessors.typepad.com/elder_law/). While many sites include information helpful to “lay” viewers, a list of some of the more useful sites for attorneys include:
1. www.elderlaw.com. The website of Tucson, Arizona-based Fleming & Curti, PLC includes access to the archives of the firm’s weekly email newsletter and details on how to subscribe, plus answers to frequently asked questions about elder law issues.
2. www.sharinglaw.net. Lisa Davis’s private labor of love includes articles on issues of concern to elders and elder law practitioners, plus links to a wealth of additional resources on elder law.
3. www.elderlawanswers.com. This commercial website, is constructed to provide referrals to member attorneys from browsers who reach the site, but it contains a useful collection of information for the caregivers.
4. www.seniorlaw.com. The website of New York lawyers Goldfarb Abrandt Salzman and Kutzin LLP contains a collection of articles, links, and resources Useful to caregivers and seniors alike.

What considerations are important in preparing an estate plan?

Although a caregiver may approach an attorney with one or two goals in mind – “I want to avoid probate,” or “I want to make sure everything is left to my daughter in trust” many considerations are involved in preparing the estate plan, and the caregiver and attorney may have to guide the recipient gently through an evaluation of all of them. Important considerations include:

1. Minimization of estate and gift taxes;
2. Whether or not to avoid probate proceedings at;
3. Planning for the client’s own future incapacity and
management of property during lifetime; and
4. The original purpose of wills-providing for the orderly transfer
of wealth to succeeding generations and to impose such
limits or restrictions as the property owner wishes to use
to encourage or prevent certain behavior, or which are
appropriate in light of the beneficiary’s own limitations.

What is the general relationship of estate planning to long-term care planning?

Although estate and inheritance tax considerations and long-term care concerns may be incorporated into the same client’s estate plan, the direct connection will appear relatively infrequently, and sometimes, the planning involved may be directly contradictory. Still, a person with tax planning issues
may _________ have a child, spouse, or other beneficiary with long-term care concerns, so a caregiver must be conversant with both tax and long-term care issues in order to adequately assess the ward’s needs.

Even though most caregivers and their wards are concerned about paying for long-term care expenses need not also fear paying estate tax, they must nonetheless be advised of the importance of estate planning as part of the long-term care plan. It may be desirable, or even necessary, to disinherit a disabled spouse or child, for example, or to provide for a spouse’s share to be held in a testamentary trust, in order to qualify for public assistance.

What is a trust?

An express trust is a fiduciary relationship with respect to property, subjecting the person by whom the property is held to equitable duties to deal with the property for the benefit of another person, which arises as a result of a manifestation of intent to create it.

Thus, a trust is a relationship between trustee and beneficiary with respect to property, the relationship having been established by the transfer, the act of another party, the “grantor” or “settler.” Only a trust permits such a division of title. In its simplest form, a trust is a relationship created by a transfer of assets to one person for the benefit of another (in some circumstances, the two persons can actually be the same person). The recipient, or holder, of the property is he “trustee,” and the person for whom the property is held is the beneficiary.” While the trustee is said to hold “legal” title to the property, the beneficiary holds the “beneficial” title. In addition, a trust is one way to provide a succession of interests over time, in the same property. Frequently, one beneficiary is entitled to the use of the property (and the income or some other portion thereof) for life, with another beneficiary to receive the interest after the death of the first beneficiary. In such a case, the lifetime beneficiary is referred to as the “income beneficiary”, and the ultimate recipient is the “remainder beneficiary”. IN addition to the trustee and beneficiary, another point in the triangle is the transferor of property, the “grantor”, “trustor”, or “settler”. The choice of terms appears to be largely regional, although the term “grantor” takes on special meaning because of the Internal Revenue Code, and most costs, understand that it is the party who subjects the property to the trust relationship, who is the true “grantor”. However, just as the word “trust” has to denote in common parlance the trust instrument itself, the paper document or documents settling forth the terms of the relationship, the concept of the “grantor”, the party transferring the property, is often confused with the party who executes the pager document that sets forth the terms of the relationship and recites that the signatory is the “grantor”.

How are “revocable” and “irrevocable” trust different and treated differently?

Historically, a trust has been presumed irrevocable unless the power to revoke is expressly reserved. This presumption is all but reversed in the Uniform Trust Code and the Restatement (Third), at least if the settler has retained any interest in the trust. When a trust is irrevocable, it is an entity separate and distinct from the creator, although this separation can be negated using certain techniques, when appropriate. By contrast, when a grantor retains the power to “revoke” the trust so that the property that is being held as a trust is restored to the grantor, from most perspectives the perspective of tax law, bankruptcy law, creditor access, and he law of entitlements-the trust property will be treated as if it still belonged to the grantor and the trust income and receipts will be viewed a directly received by the grantor. This continued alter ego status is even recognized in the Uniform Trust Code and Restatement (Third), less clearly in earlier authorities, which focus on irrevocable trusts. The general exception to this alter ego approach is the moment of death, when the rust becomes irrevocable but even there, through statutory enactment, some alter ego status may remain. Two prime examples of this are the federal income tax laws that permit the estate to “elect” to treat a revocable trust as part of the estate for income tax purposes only and the approach of the UTC and state laws that require a kind of notification to beneficiaries, sometimes (by state law) through the probate system, that the trust that was revocable has now converted, by death, to an irrevocable trust in which beneficiaries hold vested interests.

What is the difference between a living trust and a testamentary trust?

A trust established during life is usually referred to as a living trust. Whether or not assets are actually transferred to the trustee to be held pursuant to the terms set out in the trust instrument, the relationship the instrument establishes exists immediately upon creation. The term “living trust” may be used in some regions to refer to a trust that is actually funded by the transfer of property, and the more quaint Latin term inter vivos trust (between the living) to refer more broadly to all trust relationships expressed by way of an agreement between living settler and living trustee, whether or not funded. By contrast, the terms of a testamentary trust are set forth within the text of a will (that speaks at the testator’s death), and the transfer of property does not occur until the testator’s death. Thus, the testamentary trust has no viability until the death of the testator. Even though the document is signed and witnessed, the trust does not come into existence unless the testator dies without having revoked the will (and it may not even come into existence then, if the testator’s will is not submitted to probate, or if there are insufficient assets to fund the trust).

What is a revocable trust?

A revocable trust is a trust in which the settler reserves the right to revoke. Because the settler retains this level of control over the trust, the assets held in trust will be deemed fully includible in the gross for estate and gift tax purposes, fully subject to the claims of the settler's creditors, and fully available to the settler for purposes of determining the settler's eligibility for entitlement benefits. Whether and to what extent a power to “amend” a trust’s terms, whether held by the settler a third party, will cause a trust to be considered “revocable” despite the pronouncement that it is revocable, is unclear. Presumably, a limited power of amendment that cannot return the trust property to its original owner need not cause the trust to be considered a revocable trust.
Historically, a trust has been presumed irrevocable unless the power to revoke is expressly reserved. This presumption would be reversed in the Uniformed Trust Code.

What is an irrevocable trust?

An irrevocable trust is a trust that cannot be revoked (or significantly amended) once the trust instrument is signed; thus, the transfer of assets into the trust may qualify as a completed gift of a present interest in property, and the grantor theoretically gives up control of the assets once the transfer is made. By using the trust vehicle rather than making an outright gift, the grantor can dictate in advance, even from the grave, how assets are managed and distributed. Although the trust itself is irrevocable, the terms of the trust may be drafted with enough flexibility to cope with changes in circumstances. Such provisions include power to remove and replace trustee; powers held by the trustee only, to amend or reform the trust to deal with changes in circumstances; powers held by the trustee to distribute to a anew trust; powers held by the trustee to confer or take away distribution rights of beneficiaries; and the like. “Irrevocable” trusts may also be crafted as intentionally “incomplete” gifts if the grantor retains a power of appointment, creating a “step-up” in basis at the grantor’s death.

What is a special needs trust?

Outright distribution of assets to an individual who is disabled and receiving Supplemental Security Income (SSI) of Medicaid benefits may cause that person to lose those need-based benefits. The central purpose of a special needs trust (SNT) is to provide for supplemental needs without disrupting public benefits. In most cases that means protecting SSI and Medicaid benefits, although veteran’s, Section 8 housing (“public” housing), and other benefits may be involved for some beneficiaries. Because Medicare and Social Security Disability benefits are not meanstested, they are not affected by the expenditures from the SNT. SNTs can be set up to allow recipients to receive money without jeopardizing their benefits, but they must be drawn up with care to conform with state and federal guidelines. Any trust providing for the special (or extra) needs of the trust beneficiary can be said to be a special needs trust. In common usage, a SNT is any trust established for the benefit of an individual who receive (or may later receive) government benefits. The commonly used term (“special needs”) reflects that the special to the beneficiary’s disability with minimal effect on the entitlement to government benefits.

What is a power of attorney?

A power of attorney is a written instrument in which the principal authorizes another to act in the principal’s place as the principal’s agent. As a result, the agent has the “power to affect legal relationships between the principal and third parties”.[Restatement (Second) Agency § 12]. In other words, the attorney-in-fact has the power to obligate the principal and to act as the principal would act. The power of attorney can be extremely limited, giving the designee, or agent, the authority to make a single decision on behalf of the principal or to act in a single situation of ______________ so broadly written that the agent can do virtually anything the principal could do at any time. A power of attorney is effective only until the moment of the principal’s death.

What is the difference between a general and a limited power of attorney?

A general power of attorney is intended to give broad powers to the agent to make decisions on behalf of the principal, while a limited or “special” power of attorney is designed to restrict the agent’s powers to, for example, make health care decisions during the incapacity of the principal or real estate transaction powers during the principal’s absence. A classic (and common) example of the limited power of attorney is naming an agent on a single bank account, which enables the agent to draw checks on and make withdrawals from the account for the account owner’s benefit (usually to pay bills and take care of the principals needs during his or her incapacity). Another might be the document granting a closing attorney the power to sign the deed when the grantor is out of the country.

What is a “health care power of attorney”?

Powers of attorney at common law terminated with the disability of the principal, so their use was limited to commercial transaction. With the advent of durable powers of attorney in the last three decades, the classical conception of powers of attorney has shifted. Concurrent with the development of durable powers of attorney, the science of medicine developed to the point where the lives of at least some permanently unconscious individuals could be maintained for extended periods of time. Eventually, lawyers and health care advocates began to recognize the utility of durable powers of attorney for health care decision making.

Every American jurisdiction recognizes some form of health care power of attorney. Although the concept has been modeled on the commercial durable power of attorney, the specific state statute authorizing a health care power of attorney may refer to the instruments as an “advance directive” [the generic term for health care powers of attorney, “living wills” and any other health care directive), a “health care proxy”, or another similar term. Some states may have a different term for the document that grants authority regarding end of life decisions than is used for more routine health care decisions. Regardless of the state’s choice of terminology the documents have the same effect as any other durable power of attorney, except that the purpose is to provide for medical and personal, rather than commercial or financial, decision making.

What are “advance directives”?

"Advance directives” is the general term commonly used to describe all documents that state the patient’s wishes as to future health care decisions (withholding and receiving treatment) and as to the representatives who should be asked to make decisions on the patient’s behalf if and when unable to do so or unable to communicate decisions. More precisely, an advance directive describes the patient’s wishes about end-of-life decisions or other treatment, as distinguished from a “health care proxy” or “representative” that simply designates a surrogate decision maker. It is common for patients to have both or to use a document that combines both.

What is a “guardian of the person”?

A guardian of the person is an individual or agency appointed by the appropriate court to make health care, housing, and other life decisions for a mentally incapacitated person. The guardian of the person generally does not have authority to manage substantial assets of the ward. Guardianship of this type is typically sought when:

1. An incapacitated minor reaches the age of majority;
2. The elderly parents of an incapacitated individual are no longer
able to care for their child; or
3. A previously health person becomes mentally incapacitated
because of injury, alcoholism, or drug use, or the onset of
mental illness or dementia.

The very term “guardian” usually suggests guardianship of the person, although the same terminology is not used in every state. In California, for example, guardians are appointed for minor only; conservatorships apply to management of both personal and financial affairs of adults and married minors.

How are abuse, neglect, and exploitation defined?

The National Center on Elder Abuse in a study prepared for the Administration on Aging (AOA) and the Administration for Children and Families identifies the following seven types of abuse of the elderly (see http://www.ncea.aoa.gov):

1. Physical abuse. The use of physical force that may result in bodily
Injury, physical pain, or impairment. Physical abuse may include but
is not limited to such acts of violence as striking (with or without an
object), hitting, beating, pushing, shoving, shaking, slapping, kicking,
pinching, and burning. The unwarranted administration of drugs and
physical restraints, force-feeding, and physical punishment of any
kind also are examples of physical abuse.

2. Sexual Abuse. Non-consensual sexual contact of any kind with an
elderly person. Sexual contact with any person incapable of giving
consent also is considered sexual abuse. It includes but is not limited to
unwanted touching, all types of sexual assault or battery such as rape,
sodomy, coerced nudity and sexually explicit photographing.

3. Emotion or psychological abuse. The infliction of anguish, emotional
pain, or distress through verbal or nonverbal acts. Emotional or
psychological abuse includes but is not limited to verbal assaults,
insults, threats, intimidation, humiliation, and harassment. In addition,
treating an older person like an infant; isolation of an elderly person
from family, friends, or regular activities; giving an older person a “silent
treatment” and enforced social isolation also are examples of emotional
or psychological abuse.

4. Financial or material exploitation. The illegal or improper use of an
elder’s funds, property, or assets. Examples include but are not
limited to cashing checks without authorization or permission; forging
an older persons’ signature; misusing or stealing an older person’s
money or possession; coercing or deceiving an older person into
signing a document (e.g. contracts or a will); and the improper use of
conservator-ship, guardianship, or power of attorney.

5. Neglect. The refusal or failure to fulfill any part of a person’s
obligations or duties to an elderly person. Neglect may also include
a refusal or failure by a person who has fiduciary responsibilities to
provide care for an elder (e.g. failure to pay for necessary home care
service or the failure on the part of an in home service provider to
provide necessary care). Neglect typically means the refusal or
failure to provide an elderly person with such life necessities as food,
water clothing, shelter, personal hygiene, medicine, comfort, personal
safety, and other essentials included as a responsibility or agreement.

6. Self-neglect. The behaviors of an elderly person that threaten his or
her safety. Self-neglect generally manifests itself in an older person’s
refusal or failure to provide him or herself with adequate food, water,
clothing, shelter, safety, personal hygiene, and medication (when
indicated). The definition of self-neglect excludes a situation in which
a mentally competent older person (who understands the
consequences of his or her decisions) makes a conscious and voluntary
decision to engage in acts that threaten his or her health or safety.

7. Abandonment. The desertion of an elderly person by an individual
who has physical custody of the elder or by a person who has
assumed responsibility for providing care to the elder.

What is the Medicaid program?

Medicaid is a federal-state partnership welfare practice that began in 1965 to provide medical care to the elderly, blind, and disabled poor. Medicaid benefits include acute medical care, outpatient treatment, medication, and long-term skilled nursing care. Increasingly, state programs are also incorporating long-term custodial care in adult care homes, assisted living facilities, and other venues outside the traditional nursing home setting.

Because most elderly citizens are covered by Medicare for inpatient and outpatient care, the Medicaid program’s importance for the elderly lies primarily in the two benefits it provides that are not fully covered by Medicare; long-term care and (even after the adoption of a prescription drug benefit as part of Medicare) medications. Unlike Medicare which operates as an insurance program, Medicaid is designed as a welfare program with eligibility based on financial need, so that not all elderly, blind, or disabled citizens qualify for Medicaid benefits.

What is the Supplemental Security Income program?

Supplemental Security Income (SSI) [42 U.S.C. §§ 1381 et seq.] benefits are payable to elderly, blind, or disabled individuals who quality financially. It is a federal welfare program, with both financial and categorical eligibility requirements, SSI benefits may be paid to children as well as adults.

What kinds of benefits are available for veterans and their families?

Cash, health care, dental care, pharmacy services, life insurance, and burial benefits are available for eligible veterans and their dependants. Those veterans partially or totally disabled through injury or disease incurred during active training or active duty may be entitled to monthly compensation benefits. Pensions are available to veterans who served during wartime, with benefits varying according to need and degree of disability. Medical benefits, including outpatient and home care services and respite and hospice care, are provided to veterans although with significant limitations in eligibility. Finally, the dependents and survivors of veterans may be eligible to receive compensation, pensions, death benefits, and medical care. The federal statutes governing veterans benefits can be found at 38 U.S.C. Sections 101 et.seq. It is important to review the government Websites for up-to-sate information www.va.gov is the Veterans Administration Website, www.vba.va.gov; the VA benefits manual is online at http://www.warms.vba.va.gov; and Lexis-Nexis also publishes a comprehensive Veterans Benefits Manual.

What is a reverse mortgage?

The AARP succinctly defines a reverse mortgage as “a home loan that gives cash advances to a homeowner, requires no repayment until a future time, and is capped by the value of the home when the loan is repaid.” Commercial reverse mortgages may be “federally insured”, so that the payments are guaranteed by the Federal Housing Administration (FHA); “proprietary”, not guaranteed but offered through private lenders; or “private”, entered into between noncommercial parties, such as private individuals. For and away most reverse mortgages will be the federally insured mortgage insured by FHA.

OTHER SITES THAT MAY BE OF ASSISTANCE

1. Elder Law Answers (www.elderlawanswers.com) provides web listings by city, state, and area code, coupled with email newsletters, legal updates and a listserver for members.
2. The Academy of Special needs Planners (www.specialneedsplanners.com) provides a consumer website listing, access to an annual practitioner’s conference and monthly telephone conference calls, periodic email updates, and a members’ listserver.
3. ElderCounsel (www.elder-counsel.com) focuses on a document assembly system drawing on the popular Wealth Counsel program, but it also provides access to a knowledge base, monthly webinars, and other elder law community programs.
4. The Life Care Planning Law Firms Association (www.leplfa.org) is a collegial group of attorneys whose practices emphasize a “life care planning” approach to elder law.
5. The Special Needs Alliance (www.specialneedsalliance.org) is an invitation- only collaborative group of practitioners focusing on special needs planning.
6. The American Academy of Estate Planning Attorneys (www.aaepa.com) offers practice management/development advice and assistance, plus estate planning form-generation systems and educational program, but it also includes periodic seminars and a member listserver.
7. The National Network of Estate Planning Attorneys (www.nnepa.com) is a practice management/development and form-generation program, but it also includes periodic seminars and a member listserver.

FINANCIAL

Care giving can also have serious financial implications---both for the person receiving care as well as for you, the caregiver. The unexpected burden of care giving often impacts caregivers when they are still struggling with child rearing costs and trying to save for their own retirement.

The information listed below was developed by the U.S. Department of Health and Human Services and provides some estimates for care giving services at home and at assisted living facilities.

ADULT DAY SERVICES

Costs vary among adult day centers. Costs range from $23.00 a day to over $100.00 per day depending on the services offered, type of reimbursement, and geographic region. While an adult day care center is not usually by insurance of Medicare, some financial assistance may be available through a federal or state program (e.g. Medicaid, Older Americans Act, and Veterans Administration)

HOME HEALTH CARE

The cost of home health care varies across states and within states. In addition, costs will fluctuate depending on the type of health care professional required. Home care services can be paid for directly by the patient and his or her family members, or through a variety of public and private sources. Sources for home health care funding include Medicare, Medicaid, the Older American’s Act, Veterans’ Administration, and private insurance.

Medicare is the largest single payer of home care services. The Medicare program will pay for home health care if all of the following conditions are met:

° The patient must be homebound and under a doctor’s care;
° The patient must need skilled nursing care, or occupational, physical or
speech therapy, on at least an intermittent basis (that is regular but not
continuously)
° The services provided must be under a doctor’s supervision and performed
as part of a home health care plan written specifically for that patient.
° The patient must be eligible for the Medicare program and the services
ordered must be “medically reasonable and necessary”.
° The home health care agency providing the services must be certified by
the Medicare program.

To get help with your Medicare questions, call 1-800-MEDICARE (1-800-633-4227, TTY/TDD; 1-877-786-2048 for the speech and hearing impaired) or look on
The internet at http://www.medicare.gov.

ASSISTED LIVING

Although assisted living costs less than nursing home care, it is still fairly expensive. Depending on the kind of assisted living facility and type of services an older person chooses, the price costs can range from less than $10,000.00 a year to more than $50,000.00 a year. Across the U.S., monthly rates average $1,800 per month. Because there can be extra fees for additional services, it is very important for older persons to find out what is included in the ba sic rate and how much other services will cost.
Primarily, the older persons or their families pay _______________ assisted living. Some health and long-term insurance policies may cover some of the costs associated with assisted living. In addition, some residences have their own personal assistance programs.
The federal Medicare program does not cover the costs of assisted living facilities or the care they provide. In some states, Medicaid may pay for the service component of assisted living. Medicaid is the joint federal and state program that helps older people and those with disabilities pay for health care when they are not able to afford the expenses themselves. Additional information on financing can be obtained from the resources listed below.
SOURCE: Eldercare Locator, provided by the U.S. Department of Health and Human Services www.eldercare.gov Full Circle of Care, provided by Triangle J. Area on Aging http://fullcirclecare.org/caregiverissues/financial/welcome.html