Long Term Care Varies, State by State

What if your parents live in Oklahoma, you live in Nebraska and your brothers and sisters live in New York and California? Having the important conversation with your aging parents about what the future might hold if one of them should need long-term care is going to be a challenge, to say the least.

It’s not just about whether they want to leave their home, reports the article “What is the best state for long term care” from The Mercury. There are many more complications. Every state has different availability, levels of care and taxes. If the family is considering a continuing care retirement community, or if the parents already live in one, what are the terms of the contract?

The differences between states vary, and even within a state, there can be dramatic differences, depending upon whether the facility being considered is in a metropolitan, suburban or rural area. There’s also the question of whether the facility will accept Medicaid patients, if the parents have long-term care insurance or any other resources.

Here’s what often happens: you open up a glossy brochure of a senior community in a warm climate, like Florida or Arizona. There are golf courses, swimming pools and a great looking main house where clubs and other activities take place. However, what happens when the active phase of your life ends, slowly or suddenly? The questions to ask concern levels of care and quality of care. Where is the nearest hospital, and is it a good one? What kind of care can you receive in your own apartment? Are you locked into to your purchase, regardless of your wishes to sell and move to be closer to or live with your adult children?

And what happens if you or a “well” spouse runs out of money? That’s the question no one wants to think about, but it does have to be considered.

For people who move to Florida, which has a very generous homestead exemption for property taxes and no state tax, the incentives are strong. However, what if you become sick and need to return north?

For seniors who live in Pennsylvania and receive long-term care and other services, the well spouse’s retirement funds are exempt for Medicaid regardless of the amount. However, if you move over the state’s border to New Jersey, and those accounts will need to be spent down to qualify for Medicaid. The difference to the well spouse could be life changing.

Delaware and New Jersey have Medicaid available for assisted living/personal care. Pennsylvania does not. The Keystone State has strict income limitations regarding “at home” services through Medicaid, whereas California is very open in how it interprets rules about Medicaid gifting.

The answer of where to live when long-term care is in play depends on many different factors. Your best bet is to meet with an estate planning elder care attorney who understands the pros and cons of your state, your family’s  situation and what will work best for you and your spouse, or you as an individual.  The attorneys at Fisher Law LLC are well versed in Massachusetts’ Medicaid (or MassHealth) regulations, as well as the VA Aid & Attendance rules, to assist you and your loved ones on long term care issues and planning.

Reference: The Mercury (March 4, 2020) “What is the best state for long term care”

 

Can an Elder Law Attorney Help My Family?

The right elder law attorney can counsel a family through the difficult details and requirements of the situations that may come up to protect the rights and welfare of seniors and their families. An elder law attorney may help with issues, such as guardianship, conservatorship, power of attorney, estate planning, Medicaid planning, probate and estate administration and advanced directives.

The Senior List’s recent article entitled “What is Elder Law and How Can an Elder Law Attorney Help Me?” explains that because the laws on the care of the elderly differ in each state, and are always subject to change, it is essential to find an elder law attorney who is skilled, knowledgeable and up-to-date on elder law policy and legal issues.

Before meeting with an elder law attorney, create a list of the specific concerns for the present and foreseeable future, so you know what qualifications and capabilities your attorney will need. You want a lawyer who’s experienced and educated, as well as comfortable to speak with and relatable.

You can ask these questions of your elder law attorney to help you make your decision:

  • How long have you been practicing in elder law?
  • Do you stay up to date on this area of law, by ongoing study and attending seminars on this subject matter?
  • Take a look at the required services we think will be needed. Can you fulfill them?
  • Do you have litigation experience?
  • What type of fee schedule do you offer?

If you’d like to try to stay up to date on what’s happening within elder law, go online and search for “aging and disability” as well as the name of the state in which the senior lives. Every state government has a department in charge of these matters (the official names will vary).

While caring for a love done can be stressful, understanding what options are available to them and to you, can make it all much easier.

Reference: The Senior List (Oct. 10, 2019) “What is Elder Law and How Can an Elder Law Attorney Help Me?”

 

When Do I Need an Elder Law Attorney?

Elder law is different from estate law, but they frequently address many of the same issues. Estate planning contemplates your finances and property to best provide for you and your family while you’re still alive but incapacitated. It also concerns itself with the estate you leave to your loved ones when you die, minimizing probate complications and potential estate tax bills. Elder law contemplates these same issues but for those individuals who are 55+ years old and also the scenario when you may be planning for long-term care, even your eligibility for Medicaid should you need it.

A recent article from The Balance’s asks “Do You or a Family Member Need to Hire an Elder Law Attorney?” According to the article there are a variety of options to adjust as economically and efficiently as possible to plan for all eventualities. An elder law attorney can discuss these options with you.

Medicaid is a complicated subject, and really requires the assistance of an expert. The program has rigid eligibility guidelines in the event you require long-term care. The program’s benefits are income- and asset-based. However, you can’t simply give everything away to qualify, if you think you might need this type of care in the near future. There are strategies that should be implemented because the “spend down” rules and five-year “look back” period reverts assets or money to your ownership for qualifying purposes, if you try to transfer them to others. An elder law attorney will know these rules well and can guide you.

You’ll need the help and advice of an experienced elder law attorney to assist with your future plans, if one or more of these situations apply to you and you (or your loved one) are 55+ years old:

  • You’re in a second (or later) marriage;
  • You’re recently divorced;
  • You’ve recently lost a spouse or another family member;
  • Your spouse is incapacitated and requires long-term care;
  • You own one or more businesses;
  • You have real estate in more than one state;
  • You have a disabled family member;
  • You’re disabled;
  • You have minor children or an adult “problem” child;
  • You don’t have children;
  • You’d like to give a portion of your estate to charity;
  • You have significant assets in 401(k)s and/or IRAs; or
  • You have a taxable estate for estate tax purposes.

If you have any of these situations, you should seek the help of an elder law attorney.

If you fail to do so, you’ll most likely give a sizeable percentage of your assets to pay for long term care during your lifetime and then your estate to the state, an ex-spouse, or even the IRS.

State probate laws are very detailed as to what can and can’t be included in a will, trust, advance medical directive, or financial power of attorney. These laws control who can and can’t serve as a personal representative, trustee, health care surrogate, or attorney-in-fact under a power of attorney.

Hiring an experienced elder law attorney can help you and your family avoid simple but expensive mistakes, if you or your family attempt this on your own.

Reference: The Balance (Jan. 21, 2020) “Do You or a Family Member Need to Hire an Elder Law Attorney?”