5 Medicaid Dos and Don’ts for caregivers

medicaid planning for long term careWhen an elderly loved one requires long-term care, many tough decision need to made. Having Medicaid pay for long-term care can be tricky and there are many pitfalls one needs to be aware of. Having worked with seniors and their families for many years as a Medicaid consultant at Senior Planning Services, here are some common do’s and don’ts you need to be aware of.

1. Do. Set up an irrevocable trust fund for funeral and burial plots.

For Medicaid purposes, there’s what is referred to as ‘spend-down’. This means that in order to qualify for long-term care, the beneficiary needs to meet the state resource criteria. Some assets are ‘counted’ while others are ‘excluded’. Setting up an irrevocable fund for funeral or burial plot expenses can be a smart way to ‘spend down’ ones assets. Medicaid will cover for a basic funeral service and many applicants opt for a higher standard which will not be covered but will count toward the ‘spend-down’.

2. Do. Try to get in home care covered by Medicaid.

If your loved one requires long-term in-home care and is being cared for by a family member, there are some scenarios where said family member can get reimbursed by Medicaid. Check with your states Medicaid program regarding the various support programs for caregivers. For more info on the services your state offers for seniors and their families, visit: www.eldercare.gov

3. Don’t. Accept cash in exchange for providing care for a loved one.

This will be viewed as a gift. While gifting is beneficial for estate tax purposes, it does not help in terms of qualifying for Medicaid. Medicaid conducts a five-year ‘look-back’, and will impose a penalty on any gifts granted during this time. The corresponding amount will be deducted from Medicaid coverage. What you can do is have a legitimate detailed caregiver contract written up with the help of a qualified professional.

4. Do. Plan for long-term care.

Unless it is specifically requested, many estate attorneys do not take Long Term Care planning into consideration. The world has changed over the last 100 years, with the life expectancy in North America going from 47 to 82 years of age, and estate planning needs to reflect those changes. 70% of individuals 65+ will live for some time in a long-term care facility, according to an AARP study.

5. Do. Make sure you fill out that Medicaid application with utmost care, and supply all the requested documentation in a timely fashion.

Failure to submit documentation by the requested deadlines will result in a denial, bringing you back to square one. Because Medicaid will only pay retroactively from the date of the application, a denial as result of missing documentation will leave you with an astronomical bill to foot for the ‘pending period’. It is imperative that the application get done right the first time around.

Caring for a loved one can be physically tiring, emotionally taxing, and financially overwhelming. That said, there is help to be had. All it takes is a bit of planning and contacting the right resources so that the right decisions can be reached.

When Should I Take Social Security Benefit?

When should I take social security benefit?A lot of people ponder the following thought when they hit their 60’s… “When should I take social security benefit”?  I read an interesting article recently written by Tom Sightings of the blog “Sightings Over Sixty“.  The blog post was titled “The Best Time to Start Social Security”, and it discussed the variables involved when considering when to take your social security benefit.  The long and short of it is that it’s a gamble either way.  Wait a little longer and your benefit amount goes up… Take it early and you receive less.  There is no easy answer!

When Should I Start Taking My Social Security Benefit?

Tom’s article does offer some good advice when it come to making the decision however.

Tom says a person should TAKE SOCIAL SECURITY EARLY IF:

  • Your income is low and you need the money right away
  • You have a spouse who will be eligible for a larger benefit down the road
  • You don’t believe you’ll live into your 80’s


  • You are still working and generating income
  • You are healthy and have a long history of extended years ahead
  • You have large nest egg built up (at least $500K)

Do Not Delay Taking Social Security Beyond The Age of 70

One thing you need to be aware of though is that IF you can wait until 70, it’s a good idea to do so.  Your benefit will be 32% higher than at the full retirement age (which is now 65-67 depending on when you were born).  But we cannot stress this enough.  DO NOT WAIT ANY LONGER THAN 70 TO COLLECT YOUR SOCIAL SECURITY BENEFIT.  There is no incentive to do so.  You will simply be giving up those benefits that you earned over your working years.

If you’re interested in some additional information on social security benefits, see this nice PBS Posting by Larry Kotlikoff.  This article features some interesting questions and answers regarding the subject.

Where To Turn If You Suspect Elder Abuse

Elder Abuse Resources

We’ve all heard the horror stories… Caregiver neglects 82 year old in her care.  Son spends elderly parent’s savings on liquor and motorcycles.  The list goes on and on.  Would you know where to direct someone if they suspected elder abuse?

Well we’re here to tell you!  The Administration on Aging’s National Center on Elder Abuse has a great resource that provides a state-by-state resource guide that provides hotline numbers, statewide data, and statistics pertaining to elder abuse.  Click the interactive map to link up with this valuable resource.

As always, if you have some strong suspicions, please call your local authorities!  This is an issue that is incredibly under reported.

Pros and Cons of Peer to Peer Lending

Peer-to-Peer Lending- Is it Right for You?The state of the economy causes people to seek new loan options that they never would have considered in the past.  Peer to peer lending is attractive to both borrowers and lenders.  Facilitators offer many perks to make the lending process easier, including automatic payments and online filing.


Who Uses Peer-to-Peer Lending?

Many members of the same families have used peer to peer lending to lend and borrow money from each other.  Borrowing money may appear to be a simple transaction at first, but it can quickly become a nightmare.  Facilitators who are experienced with peer-to-peer lending will help with taxes and work to keep the loan separate from the family relationship.  Although family loans are common, any peer-to-peer loan transaction can occur without any previous relationship between the parties.

Peer-to-peer facilitators ensure that the loan is documented properly.  They take as much of the headache out of the loan process as they can.   A facilitator may also offer automatic payments so that the loan can be repaid without a question about the day it is due.

Pros of Peer-to-Peer Loans:

One benefit of peer-to-peer loans is that they can be used for almost any financial need.  This type of loan may be used instead of a second mortgage or a traditional bank loan because set-up fees and other fees are generally minimal.

Another benefit is that these loans require much less paperwork than traditional bank loans.  This eases the burden on the borrower to fill out a huge stack of forms and provide many documents before the loan can be funded.

Lower interest rates are another reason that borrowers choose peer-to-peer loans over traditional financing.  Low interest rates help both borrowers and lenders save a considerable amount of money.

Lenders benefit from peer-to-peer loans because they provide yields that aren’t available with traditional savings accounts or other low-risk investment options.  People who lend out their money themselves cut out the middleman, which allows them to make more in interest without having to charge a higher rate.  Even lenders who work with a facilitator typically earn more than they would through bonds, CDs or other investments.  They also get the psychological benefit of knowing they are helping out someone in need.

Cons of Peer-to-Peer Loans:

One con of peer-to-peer lending is that the lender may have to take a loss if the loan is not repaid.  The lender is also responsible for collecting the loan unless they use a loan facilitator to handle the paperwork and collection process.  Having to collect money from a family member is not something that most people enjoy, so using a loan facilitator is usually worth the cost just to have someone else doing the collecting.

Peer-to-peer loans are not insured like many other investments, so even the initial investment is at risk if the borrower defaults on the loan.  The best way for lenders to protect themselves against default is to lend a small amount of money to several borrowers instead of lending a large amount of money to a single borrower.  It is considerably less likely that many people are all going to default on their loans.

No investment is without risk, and many boomers have found that peer-to-peer lending is a wonderful way for them to help out people that they know or don’t know and make money at the same time.  Anyone who is considering using peer-to-peer lending as an investment should talk to their financial advisor about their unique financial situation before deciding if this investment is right for them.  Most lenders benefit greatly from having a peer-to-peer loan facilitator help them through the paperwork and handle the collection process for them

Paying for Long Term Care- Are You Prepared?

Paying for long term careAmericans are doing little to prepare for long term care and are not very concerned.  Maybe they don’t need to be concerned, but they should be terrified!  A recent poll released by AP-NORC Center for Public Affairs Research, and reported in the national media, verified a major factor contributing to the long term care funding crisis in this country: Two out of every three people over the age of 40, according to the poll, have made no plans regarding paying for long term care, and it is a topic they prefer to not consider.  The irony is that seven out of ten people will need long term care services once they pass the age of 65.  The poll also showed the continuing lack of understanding about how long term care is funded.  Misconceptions continue that Medicare will pay for anything more than 100 days of skilled nursing rehabilitation care.  Health insurance plans don’t cover long term care services, long term care insurance is limited and restrictive in coverage, and Medicaid will only cover long term care (primarily nursing home) once a recipient has spent-down their assets to below the poverty level.

The irony is that seven out of ten people will need long term care services once they pass the age of 65 – AP-NORC Center for Public Affairs Research

The growing population of Boomers retiring, and seniors requiring long term care services is creating enormous pressure on the system and an urgent drive to find new private pay solutions.  One private pay resource that is on the rise is converting life insurance policies into Long Term Care Benefits.  Millions of seniors own life insurance policies that they are in danger of abandoning without realizing they could quickly and easily convert the policy into a monthly Long Term Care Benefit Plan.  These Benefit Plans will pay for any form of long term care service including home care, assisted living, and skilled nursing care; and any type of life insurance policy will qualify for conversion.

Private Pay Solutions Emerge

The long term care industry has been quick to embrace this concept and today thousands of assisted living communities, nursing homes and home health companies accept this funding method.  Political leaders too have begun to realize the cost saving implications for their beleaguered Medicaid budgets by extending the time a person could remain private pay before becoming Medicaid eligible through the conversion of a life insurance policy as an alternative to abandoning the policy through lapse or surrender.

Medicaid is a government program designed to help cover health care costs for the indigent (poor), disabled and children and/or dependents.  The eligibility process is determined by asset and income levels that would measure an applicant as being below the poverty level.  One of the assets that will count against a Medicaid applicant is a life insurance policy.  The owner of the policy must surrender the policy for any cash value and spend it down on care, or if the policy has no cash value and the owner keeps it the estate will be subject to federally mandated asset recovery probate action against the death benefit collected by the estate to claw back all Medicaid expenditures.  Because of this reality, financial planners, elder law attorney’s and geriatric care advisers have provided seniors and their families with the default guidance that in the case of ownership of life insurance policy (not including funeral policy exemptions), a life insurance policy still owned by the senior inside the 5 year look back period should be abandoned.

Medicaid is a government program designed to help cover health care costs for the indigent (poor), disabled and children and/or dependents.

Political Support Arrives Just in Time

States are now coming to the realization that there is a much higher value found through the conversion of a life policy that can be deployed to extend private-pay as a Long Term Care Benefit Plan.  Any owner of a life insurance policy has the legal right to convert it into a Long Term Care Benefit Plan.  In 2010, the National Conference of Insurance Legislators (NCOIL) passed a national consumer protection model law that would mandate life insurance companies must disclose to policy owners about their legal right to convert their life insurance policies instead of abandoning them via lapse or surrender.  The life insurance industry opposes anything that would discourage policy owners’ from abandoning their life insurance (because life insurance companies make huge profits off of seniors that have paid premiums for years and then abandon their policies in the last years of their life).

Since passage of the NCOIL national model law; legislation has been introduced in numerous states to empower Medicaid departments to educate citizens that the conversion of their life insurance policies is their legal right and a better option than abandonment of their policies.  As of May 2013, the states of FL, TX, KY, LA, and ME have introduced this legislation and numerous other states are preparing to introduce the same bill for enactment.  Over the course of this year and next, people will continue to become more aware of their option to convert a life insurance policy to pay for long term care.  All across the country the long term care industry and political leaders are looking for private pay options that not only help people pay for long term care, but save the tax payer money by delaying Medicaid eligibility.

Paying for Long Term Care: Three Clear Winners

1.     The policy conversion option is a clear winner for seniors and their families; providers of long term care services; and for tax payers in every state.  The policy owner and their family are able to convert a life insurance policy and use the proceeds in a Medicaid qualified spend-down to extend the time they are private pay before moving to government assistance.  This allows freedom to choose the form of care they want, as well as financial control and dignity for themselves and their families.

2.     Providers of long-term care services benefit because they are operating under extremely thin margins and private pay dollars translate into higher quality services for covered care.

3.     The longer a person can remain private pay before becoming Medicaid-eligible, the more budget/tax savings for the us tax paying citizens.

Policy Changes to Medicare Will Keep You In Therapy Longer

policy changes to MedicareMy first job as a social worker was in skilled nursing facilities, aka nursing homes.  While I loved many aspects of my job, I dreaded the weekly meeting that was held to determine which Medicare patients were making progress from our therapy services (and which were not).  Those who were deemed to be plateauing and no longer benefiting from physical, occupational, speech, respiratory, or skilled nursing therapy services were given a 72 hour written notice from our team.  This notified families that Medicare would no longer be covering their stay in our rehabilitation facility.

For many patients, this meant a scramble to find alternative care settings, or arranging services to be brought into their homes for the transition.  No one was happy to see me walk in the door with that letter.  It meant that Medicare had given up on them with that particular injury.  Some would appeal our decision, but it was rare that the ruling would be in their favor.  Luckily, policy changes to Medicare were on the horizon.

The saddest cases were those that had some form of dementia along with their diagnosis (broken hip, stroke, etc…).  These folks simply could not follow the instructions given to them in order to make progress with their injury.  Typically they were discharged just a week or two after admission… And they were the lucky ones.  They had straight Medicare, not an HMO or they would have been shown the door earlier. But that’s for another post.

So, it is with great pleasure to have learned about new policy changes to medicare that will have an immediate effect on this process.  A federal court settlement in Jimmo v. Sebelius has been approved.  New policy provisions will state that skilled nursing and therapy services necessary to maintain a person’s condition can be covered by Medicare.  This replaces the “improvement standard” that providers have subscribed to for years.  

According to Medicare Advocacy.org “CMS will undertake a comprehensive nationwide Educational Campaign to inform health care providers, Medicare contractors, and Medicare adjudicators  that they should not limit Medicare coverage only to beneficiaries who have the potential for improvement.  Instead, providers, contractors, and adjudicators must recognize “maintenance” coverage and make decisions based on whether a beneficiary needs skilled care that must be performed or supervised by a professional nurse or therapist.”

To break it down, Medicare recipients can’t be kicked off skilled services (therapy services such as PT, OT, etc…) simply because they aren’t making significant improvement.  In the case of the Medicare recipient with dementia and a fractured hip, he/she will now receive therapy services despite the dementia diagnosis until the hip is treated to maintain his/her current condition and to prevent further decline.

“Lawyers for the beneficiaries say the settlement could help people with chronic conditions like Alzheimer’s, Parkinson’s, multiple sclerosis, strokes, spinal cord injuries and brain trauma. Often the prospects for improvement are slim, but there are ways to slow a patient’s deterioration and help the patient to live long enough to take advantage of new treatments as they are developed.” New York Times

While substantial costs are expected to be added to the Medicare program because of these changes, there may also be savings realized if recipients can receive therapy services in their homes.  The increased therapy should also keep these patients out of more costly settings like hospitals and nursing facilities and keep readmission rates low.

To learn more about the settlement, or if you would like to appeal a past decision made by a Medicare provider, the article from the Center for Medical Advocacy has many helpful links and resources.

Mobile Help Now Acquires Halo Monitoring

Mobile Help Now logoplus signMobile Help Now acquires my Halo Halo Monitoring

Mobile Help Now Acquires Halo Monitoring

If you weren’t aware, Mobile Help (Boca Raton, Florida) has acquired a company we’ve had our eye on for quite some time, Halo Monitoring (Halo’s website now redirects to MobileHelp).  The consolidation could be good or it could be bad for the PERS-Medical Alarm market depending on how you see it AND depending on what Mobile Help does with the Halo technology.  IF they invest, improve and expand the my Halo platform it’s probably a great thing for the fall detection market.   IF they bury Halo Monitoring, it’s one less choice for consumers and a waste of a once promising technology.The myHalo Fall Detection Device

Here are some excerpts from the MobileHelp press release entitled MobileHelp acquires Halo Monitoring to build out PERS offering.

“The acquisition of Halo Monitoring is an important step on our journey to expand our solution portfolio of Home Healthcare and Monitoring solutions that further improve the well-being of seniors who rely on our products,” Rob Flippo, CEO of MobileHelp said in a statement. “We are excited to add additional capabilities to our best-in-class mPERS offerings, in addition to bringing on board talent to further expand our technology capabilities.” – Brian Dolan, MobiHealthNews

Medical Alert SystemsMobile Help Now hand held unit

The Senior List has written extensively about Personal Emergency Response Systems including Fall Detection Devices.  Click through for a short list of medical alert systems available today.  From there, you’ll be able to read our reviews of medical alert systems and become familiar with the different types of medical alert choices for aging adults.

Mobile Help Now | The myHalo chest strap Fall Detection DeviceHalo Monitoring was one of the first companies to include automatic fall detection in its wearable PERS devices, which send an alert to caregivers and/or a call center when the person wearing the pendant falls — it does not require the wearer to push any buttons to trigger the alert. – Brian Dolan, MobiHealthNews

 mobile help now acquires my halo monitoring

Caregiver Financial Assistance For Veterans

Caregiver Financial Assistance For VeteransA recent article in the NY Times New Old Age Blog (one of our favorites) caught our attention and it seemed significant enough to pass along.  We’d also encourage you to pass this knowledge on to friends and family members.  The article was titled “A Little-Known Benefit for Aging Veterans” by Susan Seliger and it discusses  a veteran benefit few know anything about (those of us that work in the field call it Aid & Attendance).  Did you know that qualifying veterans can receive financial assistance from the Department of Veteran’s Affairs to help with caregiver costs?  This is called Caregiver Financial Assistance For Veterans.  Apparently not many do…

Note the list of qualifying criteria and definitely read through all the comments as well (there are many helpful hints, and also a lot of frustration with the bureaucratic process).  According to the article, only 38,076 veterans were granted this benefit in 2011.  To put that in perspective, see the illustration below from a department of veterans affairs fact sheet and note how few veterans actually took advantage (no doubt it’s because so few are aware, and countless others give up as a result of the arduous application process).  Given the scrutiny of deficit spending these days, you may want to take advantage of this program (if you qualify AND if you need it) before it goes away.

Senior Housing Referral Agencies

Senior Housing Referral Agencies

What Is A Senior Placement and Referral Agency?

A senior housing referral company helps clients locate appropriate senior housing in a given geographic area.  A reputable placement and referral service can save you time and energy in your search for senior housing. They should know which communities can supply appropriate care and be able to refer their client to all types of communities. To validate the reliability of a referral company, ask them if they work only with communities that they have contracts with or if they will also refer you to communities that won’t sign contracts. Also, make sure they have personally toured each of the prospective communities and see if they collect information on both substantiated and unsubstantiated complaints. Finally, when looking for a referral agency, choose one that provides you with a list of suitable living options and will escort you on visits to the properties at your request.

Referral companies who do not charge clients for their services will expect the client to work with them exclusively; Referral companies gather similar information, so there is no need to work with more than one. This type of referral company receives a “finder’s fee” from the community that the client chooses. Other types of senior referral companies may charge for their services at hourly or set rates. When working with a fee-for-service company, make sure to get the charges in writing before you begin the referral process.

When working with a referral company, let them know your needs, preferences, comfort levels, and expectations. Be honest and straight forward. The more information you provide to them, the better they can serve you and find a place that will best suit your needs.

Choosing suitable housing for a loved one is an important decision for you and your family. Utilizing a referral company will help ensure you find a great place.

Top 10 Moving Tips For Seniors

Moving Tips For SeniorsWhether moving from one home to a similar size one or downsizing to a smaller one, moving is not just an event but a process.  It starts when you first consider the possibility of a change and continues through many stages until you are settled into your new place and feel comfortable enough to call it home. At times this process may feel overwhelming and your moving goals may seem out of reach. There are some steps you can take along the way to make sure this project moves forward in a smooth and efficient way. This is our top 10 moving tips for seniors.

10 Moving Tips For Seniors

10. Make a plan

Begin by making some key decisions. Ask yourself how much of the moving process you want to do yourself. Will you hire a move manager or movers to just do the moving or will they do the packing also? Will you be placing additional items into storage?  Next, start from your moving date and work backwards to create a timeline of actions that need to be done before the move. Keep a notebook of all your “to do” items, the mover’s contact information, and material gathered about the various aspects of your move.

9. Start early

It’s never too early to start downsizing. Even if you have not settled on a moving date or the exact place you will be living, you can still start this process. Begin by focusing on problem areas that tend to collect extra items. Those spaces can be the attic, basements, garage or closets.  Take time to work through the papers in your filing cabinets as well.

8. Break it into smaller tasks

Accomplishing a large task like moving or downsizing can be overwhelming if you view it as a whole.  When the job is broken down into smaller pieces, it becomes more manageable.  It took years to accumulate what you have, so it may take some time to work through it all.   Choose one small area, such as a cabinet or a drawer, and start working there.  Doing a small amount each day will move you easily forward towards your goal.

7. Plan out your space

It is helpful to know what the size of your new home will be.  Using the square foot measurements of both your present home and your new home, you can calculate the percentage of your downsize. If you currently are living in 2,000 square feet and plan to move to 1,000 square feet, you will be downsizing by 50%.  This should be your guideline as you make decisions about furniture, collections, books and even clothing. Use a floor plan of your new home and cut out furniture templates to determine what pieces of furniture will fit and where the best location for each piece will be.

6. List what is important

Take time to clarify which possessions are really important to you, not just what you like or are used to having around. Sometimes it helps to ask yourself the question, “If I had only 5 minutes before disaster hit my home, what would I grab to preserve?” This process will help identify items you want to make sure to move with you.  Moving can be expensive.  The more “stuff” you have, the more it costs. Don’t move things that you don’t need, but be careful to take the things that are most important.

5. Save your memories

As you sort through your possessions, some are easy to part with, but others have significant personal value.  Everyone has possessions that are kept not for their usefulness but for the memories or sentiment attached to them. When a treasured item is identified, the question then becomes: Can the associated memory be saved in another way or is the item something that you should carefully preserve for yourself or future generations? There are many ways to keep the memory without actually keeping the physical item. Photos can be scanned and stored electronically, special collections like teacups can be photographed and displayed on the wall, or swatches of your favorite t-shirts can be made into a quilt.

4. Let go/ Share with others

One of the hardest things to do when you are downsizing is to let go of your possessions. It is difficult to just get rid of them, because you know their value. They may still have good life left in them or can be used another way. Finding a place where they are needed or knowing that they will be used and enjoyed by other makes letting go of these items much easier.  A variety of agencies and non-profits use your goods to benefit others or will wisely recycle them. Consider what interest or cause is important to you and then support that cause by donating your items.

3. Stay in touch

Notify your contacts with your change of address. Remember to include the post office, friends, family, publications, associations, and banks.  It’s great to prepare these in advance but mail them just one week before the move.  Set up the transfer/termination of utilities. Consider paying for one more day than you think you might need in case you have to go back to finish cleaning, to pick up the last few items or if the movers are delayed.

2. Prepare for moving day

Pack a suitcase as if you were going away for a few days.  Even if you are only travelling a short distance, it is helpful to have everything you need to get ready the next day contained in a suitcase, instead of buried in several different boxes. Be sure to include clothing, toiletries, and medicines you will need. Create an “Essentials” box. This will be the last box packed and the first one unpacked. It should contain items that are most immediately needed at both ends of your move. Include supplies like toilet paper, paper towels, soap, paper and pen, trash bags, first aid kit, scissors, phone book, snacks, towel, bedding, and tea or coffee pot.

1. Ask for help!

Moving can be stressful emotionally, physically and mentally. This is an exciting and stressful experience, so allow others to join with you in both the joy and the burden of the move.  Ask others to be involved but don’t wait until last minute to seek their support.  Whether it is assisting with physical packing or organizing different details of the move, take people up on their kind offers.

Whether you are shifting your space around to adjust to a new physical need, moving your household across town or transferring to another country, these tips will make it a bit more bearable for you. This top 10 list will help make your moving process easier and more organized.   ©2012 Beth Giles