One of the greatest fears of older Americans is that they may end up in a nursing home. This not only means loss of personal autonomy, but also a tremendous financial price. Depending on the location and level of care, nursing homes can cost between $3,000 and $10,000/month! It’s a difficult decision just to determine that mom or dad needs to enter a long term care facility. But now you’re faced with a huge problem: How will I pay for mom and/or dad’s long term care?
As an Estate Planning and Elder Law law firm, this is one of the most common worries that our clients express at the initial consultation. Unfortunately, often times this becomes a concern only AFTER mom or dad has entered a long term care facility. At this point our available options are much fewer in number. But don’t worry, options do still exist!
There are essentially 3 different ways that clients can pay for long term care. While the first two options are relatively simple and straightforward, it is the third option that, with appropriate planning and foresight, can offer the most benefit.
One option for tackling long term care expenses is to self pay. Most people end up paying for nursing home care out of their savings until they run out. Then, at that point, they can qualify for Medicaid to pick up the cost going forward. Well, what if mom or dad would like to save some money for a healthy (“community”) spouse? What if they would like to leave money to you, their children? Through careful planning, especially in advance of this need, you can help protect your parent(s) estate.
A second option for paying for long-term care is to purchase long-term care insurance. There are certainly some advantages to purchasing long-term care insurance: 1) You choose how you will pay for long-term care; 2) You choose where the care will be received; and 3) You can choose who will provide the care. There are two major problems with the long-term care insurance route. First, people often buy a policy that is insufficient to pay for the entire cost of care. If the nursing home costs $180/day, and policy that pays $30/day is not very helpful. It is a good idea to be sure your policy adjusts its payments with the increases in cost of care over time. The second issue we often see is that, by the time we think about long-term care insurance, mom and dad are uninsurable! It’s too late!
Your third option to check out is whether or not mom or dad is (or can be) eligible for a government benefit. To maximize government benefits, it’s very helpful to start planning at least five years before mom or dad would need to enter a long-term care facility. However, some benefits may begin right away! There are two government benefits, which I will briefly discuss, that are not utilized as much as they could be. There are many people that could easily qualify with some simple planning and some of these people are already qualified!
MEDICAID
The reason planning needs to begin five years before nursing home care will be needed is because Medicaid in Missouri has a five-year “look back”. This means essentially that when you apply for Medicaid, the State will “look back” five years to make sure mom and dad haven’t given away any of their assets. If they have given away any assets (including to an irrevocable trust), then a “penalty period” is created. This penalty period creates a period of ineligibility for Medicaid benefits, which will not begin to run until mom or dad otherwise qualifies for Medicaid and the application is submitted. The length of the “penalty period” depends on the size of the transfer.
To be eligible for Medicaid, one must be at least 65 or blind or disabled. The applicant must also have less than $1,000 in “countable assets”. Finally, the applicant’s long-term care expenses should exceed his/her income. (This makes sense, since the State will take mom and/or dad’s income and, in exchange, will pay the long-term care expenses). “Countable assets” are essentially any asset in mom or dad’s name other than: 1) their homestead; 2) one vehicle; and 3) EITHER a) life insurance with cash value under $1500; b) burial plot; c) burial plan; d) pre-paid funeral.
For specific solutions to your parent(s) Medicaid eligibility, please seek the guidance of an Estate Planning and Elder Law attorney.
VETERANS AID AND ATTENDANCE
The second government benefit, is a benefit that not near enough people know about: Veterans Aid and Attendance. It is available to all (honorably discharged) veterans who served at least 90 days active duty, 1 day of which was during a period of war (the veteran NEED NOT have served in combat). This benefit provides supplemental income to disabled or older veterans who are disabled for reasons other than service-connected injuries or illnesses and who have a low income. This benefit is also available for surviving spouses or dependent children of deceased veterans.
It is abosultely amazing to me, the amount of people eligible for this benefit who do not no about it. According to the 2007 Statistical Abstract of the United States for the most recent year of 2005. There were 7,091,000 living veterans, over 65, of the Korean Conflict, Vietnam War, WWII or the Gulf War. There were also an estimated 4,369,000 surviving spouses or dependent children of deceased veterans. This makes a combined 11,460,000 potential Aid and Attendance beneficiaries. In 2007, there were only 543,000 Aid and Attendance beneficiaries. That means that only 4.7% of potential beneficiaries were taking advantage of this great benefit!
There are, of course, some other eligibility requirements based on both assets and income.
ASSET TEST — Household cash assets or assets that can be readily converted to cash cannot exceed $80,000. There is no specific test below $80,000. A Veteran’s Service Representative will decide on a case-by-case basis what the allowable level of assets should be. Personal residence, vehicles and personal property are exempt from the asset test
INCOME TEST — The veteran household countable income must be less than the Maximum Allowable Pension Rate. As a practical matter, the veteran household’s unreimbursed daily living expenses must exceed total income.
If these criteria are met, a single, living veteran can receive an additional $1644/month; a veteran couple can receive $1949/month; and a surviving spouse of a veteran can receive $1056/month. Now that is a LOT of money to be leaving on the table!
This money could be used . . . to pay any person (including CHILDREN) to provide home care. . .to pay for PROFESSIONAL home care services. . .to pay for ASSISTED LIVING. . . or to pay for a NURSING HOME.
To determine if you or your parents may qualify for this benefit and in order to maximize your benefit with the least amount of time for processing your claim, seek the guidance a qualified Estate Planning and Elder Law attorney.
If you have specific needs or questions, it’s always best to speak directly with a licensed attorney in your area. Although our firm generally serves the Greater St. Louis metropolitan area, we would love to help you with any Estate Planning or Elder Law needs.
Even if you are outside of the Greater St. Louis area, feel free to call our office at 314-966-8077 or email me at pgantner@yourestatematters.com. If we cannot help you ourselves, we would be happy to refer you to an attorney in your area.
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Best,
Paul Gantner
Attorney at Law
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