VA Benefits & Planning and How It Effects Future ALTCS Eligibility

Seniors and the Law is authored by the attorneys at JacksonWhite Attorneys at Law and addresses legal issues that arise for the elderly and their families.  Questions can be sent to firm@jacksonwhitelaw.com.

Q:        About two years ago, a financial advisor helped my parents devise a plan by which my dad, a veteran, could qualify for VA Pension.  This plan involved funding an annuity and establishing a trust.  The VA Pension now provides my parents with additional monthly income of about $2,000, but they are still having difficulty paying for dad’s care.  I looked into the ALTCS benefit, but discovered that the type of VA planning in which my parents engaged might create problems.  What should I do?

            Without knowing the particulars of your parents’ situation, I can’t be certain how things transpired here, but I can give you my best guess.  I have met with numerous clients whose financial advisor helped them prepare for VA benefits.  All too often, I find that these VA plans come at the expense of eligibility issues for the ALTCS program. 

It sounds like your parents’ advisor might have funded an annuity product, and transferred that annuity to an irrevocable trust.  This type of strategy can facilitate eligibility for VA benefits because the VA does not have a look-back window, so transfers to a trust can help a VA applicant satisfy the VA resource requirement.  While this strategy works for VA, however, it does not work for ALTCS. 

ALTCS looks back five years for uncompensated transfers – including those to a trust – and imposes a penalty based on the amount of the transfer.  As such, if your parents’ planning involved a transfer to a trust, it could be that ALTCS will not grant approval until the penalty period lapses. 

This situation underscores the importance of working with somebody who understands all of the benefits to which an applicant might be entitled.  While your folks might be able to undo the damage in this case, they would have been much better off contemplating ALTCS rules at the outset.

             Richard White is an elder law attorney at JacksonWhite Attorneys at Law.  For more information on Elder Law at JacksonWhite, please visit www.ArizonaSeniorLaw.com.

This article is provided for informational purposes only and is not intended to replace individual legal advice.

Visit us at www.arizonaseniorlaw.com 

4 Fears Surrounding End of Life Care and How to Overcome Them

 

Many families find conversations about end of life care difficult to broach with a parent or aging loved one, but surely they have come up.

Perhaps you were driving away from a nursing home visit with your mother when she told you she “never wants to live in a place like that.”

Or, maybe you were sharing coffee after a family funeral when your father told you that he “never wants to be hooked up to ventilators like Uncle Mark was.”

Statements like these open a window into their desires as they relate to end of life care, but they don’t provide you with the full picture you need to adequately plan ahead.

The 40-70 Rule^® is a good rule of thumb: have an intentional conversation surrounding these concerns by the time you are 40 and your parent is 70. But no matter your age, it can bring immeasurable peace of mind to communicate openly with your family about end-of-life fears and wishes so you can plan ahead to ensure those wishes are honored.

Here are a few of some of the most common fears and ways to overcome them.

Fear #1: “I hate the thought of having feeding tubes and ventilators keeping me alive.”  What you can do about it: Consider establishing a living will. Living wills detail an individual’s treatment preferences in the event he or she is unable to make those decisions for him- or herself. The requirements for living wills vary from state to state, so you should also consider having a lawyer assist with this. Many lawyers will prepare a living will as part of an estate planning package.

Fear #2: “I’m afraid I will end up in a nursing home, and I don’t want to die in a hospital or institution.” What you can do about it: There are many options for end of life care outside of nursing homes and hospitals. Make sure that you have a conversation with your parent about his or her wishes and look into home care options together so that you areprepared when the time comes.

Fear #3 “What if I get dementia and can no longer make my own decisions?”  What you can do about it: It’s wise to have your parents designate a trusted person with power of attorney (POA) who will act on their behalf in the event that they are no longer able to advocate for themselves. Designating a person with POA will give them peace of mind that their care wishes will be met regardless of their mental acuity.

Fear #4: “I don’t want to lose my independence.”  What you can do about it: Look into the home care options in your area so that your parent can have the help they need to continue living independently at home without feeling like they have to rely on you to help meet their daily needs.

The best way to address the end-of-life fears your parent may be struggling with is to communicate clearly with them about their wishes in advance. If the topic doesn’t come up naturally, set up a specific time to talk.

Try to remain open and put yourself in your loved ones’ shoes to better understand their wishes and the reasoning behind them. Be sure to record your discussion by taking notes so you have something to refer back to when making plans and decisions in the future.

For many, it’s normal to feel anxiety surrounding this topic, but know that having open communication with your loved ones will likely give your family a sense of peace that will far outweigh any anxiety you feel broaching the subject.

For additional guidance when it comes to discussing end-of-life wishes with your loved ones and developing a plan, download the 40-70 Rule: An Action Plan for Successful Aging^SM.

For more useful information visit us at http://www.homeinstead.com/pages/home.aspx

Home Care Services? How To Choose and Medicare Eligibility Requirements & Payments

Services – Home Care – How to Choose?

When a loved one needs home care services, the following guidelines can ensure you select the most reliable, reputable provider to deliver the care he or she needs.
Determining Needs

• Be sure you are fully aware of the home care services your loved one requires by consulting his or her physician.
• Obtain a list of area home care agencies from either a doctor, social worker or case manager. You can also get recommendations from friends, neighbors, and your church or temple.
• Contact these agencies to determine their service offering and to learn more about their practices.

Ask the right questions

• Ask how long the provider has been serving the community to determine the reliability and stability of the agency.
• Find out if the provider furnishes patients with a Patient’s Bill of Rights, which outlines the rights and responsibilities of the provider, the patient and the caregivers.
• Inquire about the agencies hiring practices. Do they perform criminal background checks?
• Do they carry liability insurance on employees?
• Ask about staff training. Is the training ongoing? Are staff members required to complete a set amount of in-service training hours each year?
• Inquire about the patient evaluation process. Is a nurse or therapist required to evaluate the patient’s home care needs? What is involved in this evaluation process? Is the patient’s physician or family members consulted?
• Find out how the plan of care is developed. Are the patient and his or her family members involved in the development of the plan of care? Are they involved in making changes to this plan? Is there a separate plan of care for each discipline whether it is nursing, physical therapy, occupational therapy, etc.?
• Ask how the delivery of care is supervised. Who is assigned to oversee the quality of care being delivered? How often are supervisory visits conducted? Who is available to address questions or complaints? Are caregivers available 24 hours a day, seven days a week?
• Ask if the agency participates in quality assurance programs such as the one organized by the Joint Commission on Accreditation of Healthcare Organizations, which evaluates quality of care and operations to determine compliance with national health and safety standards.
• Ask for a list of references such as doctors, discharge planners, patients and their family members, community leaders, etc.

Services – Home Care – Medicare & Payment

Home care services are covered under Medicare Part A for those who meet the eligibility requirements as well as certain criteria defined by Medicare. When patients are not sure if they meet Medicare qualifications, Life Care at Home agencies will do a complimentary evaluation to determine whether or not they are eligible. For those who do not qualify for Medicare coverage, other payment options may include Medicaid, private insurance, private pay and HMOs.
Medicare Part A coverage requirements
To be eligible for home care benefits under Medicare Part A, a patient must:

• Require at least one of these three services: skilled/intermittent nursing care, physical therapy or speech therapy
• Have a doctor’s order for home care services
• Be homebound and require occasional visits by a home care professional who performs a specific task such as giving an injection, changing a wound dressing, or providing instruction on a disease process or medication.

Occupational therapy, medical social worker services, and/or home health aide services are only covered by Medicare if the physician recommends the service along with skilled/intermittent care, physical therapy or speech therapy.
Medicaid coverage
Medicaid, state health insurance programs may pay the cost of home care services; however, coverage guidelines vary from state to state. To find out which services may be covered in your area, contact your state’s medical assistance office.
Private insurance
Private insurance typically covers the cost of skilled/intermediate care, physical therapy and speech therapy. Some insurance companies provide supplemental policies to cover additional home care services such as occupational therapy and sitter services.
Private pay
For those who are not eligible for Medicare or Medicaid benefits and are not covered by private insurance, expenses for home care services can be paid by the individual or his or her family.
HMOs
Individuals enrolled in an HMO can expect the cost of skilled/intermittent nursing care, physical therapy and speech therapy to be covered. However the policies regarding coverage for other home care services varies depending on the HMO. For more specific information about payment of home care services, contact your HMO.

Visit our website today to learn more  http://www.lcca.com/services_home/ 

5 Qualities To Look For In Home Care Service

5 Qualities to Look for In Home Care Service

We recently wrote about the research we conducted that identified the higher standard of home care that families are seeking when they have a loved one in need. However, families looking for quality care also find themselves faced with a lack of clinical quality standards within the private duty in-home care sector. That’s why we’ve pulled together some key qualities that families should look for to identify a qualified care option.

In addition to a lack of clinical quality standards, a general lack of knowledge of the industry can make it difficult to find a care solution that makes sense. Here are 5 qualities families should look for in any home care agency they may be considering:

1. Availability. Operates on a 24 hours a day, 7 days a week basis as many home care providers only operate during “regular business hours.”
2. Registered Nurse oversight. Provides a comprehensive health and wellness evaluation conducted by a Registered Nurse with the expertise to craft a personalized plan of care around a loved one’s unique interests, personal, and healthcare needs.
3. Trusted. Employs and oversees experienced, screened, compassionate, and trained nurses and caregivers.
4. Core Values. Stands by its core values and ensures that the client will get the care they need and deserve.
5. Accreditation. Committed to care standards that are validated through a major third-party healthcare standards accrediting body, like The Joint Commission.

Sharon Roth Maguire, MS, RN, GNP-BC, Chief Clinical Quality Officer for BrightStar Care®, noted that families should closely examine clinical quality when choosing an in-home care provider.“Our Clinical Quality standards give families tremendous peace of mind that their loved ones are receiving the best of care from qualified professionals,” Roth Maguire said. “When we talk about ‘A Higher Standard of Care,’ we deliver on that message with our unique best practices such as the active involvement of our RN Director of Nursing in every client’s care, the oversight of our direct care team by our RN who does face-to-face in-home supervisory visits, competency testing of select caregiver skills, as well as person-centered client reassessments and plans of care designed to optimize client’s health and wellbeing.”

For more information about BrightStar Care, contact our team 24/7.

Healthy Aging ~ 10 Tips for Getting Fit

Healthy Aging: 10 Tips for Getting Fit

As you grow older, an active lifestyle is more important than ever. If you are struggling with activities of daily living, you may want to consider assistive or personal care services.  Self-care assistance can help you incorporate and maintain a basic exercise regimen to prevent or reduce the risk of many health conditions, which can positively affect the length of your life.

A study by a team of researchers from National Cancer Institute, part of the National Institutes of Health, found that people who engaged in leisure-time physical activity had life expectancy gains of as much as 4.5 years.

The health benefits of regular, moderate exercise can’t be overstated: it can help lower your risk of heart disease, stroke, type 2 diabetes, and some types of cancer. An active lifestyle can also improve your strength and balance so you can prevent injuries and stay independent, reduce symptoms of depression and stress, and improve your ability to think, learn, and make decisions.

With so many health benefits, exercise should be a priority in everyone’s life, but, unfortunately, that’s not the case. Some people feel discouraged by illness, ongoing health problems, or concerns about injuries or falls. Regardless of your health status, your fitness level, or your inexperience with exercise, you can safely work energy-boosting, heart-healthy, mood-enhancing exercise into your week!

So, let’s get moving!

Here are some tips for getting the most out of an exercise routine: 

1. Evaluate your health status 
   It’s wise to speak with your doctor before you begin any exercise regimen. Ask if there are any special precautions you should take to keep safe or if there are any activities you should avoid based on your current health and fitness level.
2. Start small 
   Enthusiasm is great, but trying to do too much too soon can derail your efforts by causing an injury or over-stressing your muscles. If just starting out, walking is an easy activity to get you moving. Even 10 minutes a day, twice a day, will do your body a world of good. “No pain, no gain” does not apply; stop if you have pain or shortness of breath. Check with your doctor before resuming activities.
3. Choose activities that are fun for you 
   The more you enjoy what you are doing, the better results you’ll get. If you like to work out in a gym, that’s great. But if you prefer tennis, swimming, or biking, then choose those instead. Do you like to dance? Go for it!
4. Recruit a workout buddy 
   Exercising with a companion is always more fun and motivating. Plus, it helps keep you accountable.
5. Focus on short-term goals 
   For people who want to lose weight, for example, the thought of reaching their ultimate goal can be overwhelming. Instead, set short term goals or focus on other benefits like increased flexibility, improved balance, and enhanced mood. 
6. Alternate 'easy day' and 'hard day' workouts 
   Once you get in an active groove, you’ll get greater benefits by alternating more intense workouts with easier ones. For example, if you walk one day for 40 minutes, only walk 20 minutes the next day. It’ll give your body a chance to recoup while still remaining active. 
7. Mix it up  
   As much as you may enjoy walking, your routine get can get, well, routine. Adding in a variety of different activities is a great way to keep you motivated. So, instead of your morning walk, how about taking a swim or a doing a yoga class? 
8. Join a gym or class 
   There’s nothing like participating in a group activity to keep you going. It’s fun and social.  Who wants to be asked, “Where were you?” when you didn’t show up in favor of sitting on the couch?
9. Seek expert advice 
   A personal trainer can help design an exercise routine that’s tailored just for your personal fitness level and wellness goals. A trainer can also teach you how to perform exercises safely to ensure you won’t fall or injure yourself.  
10. Be active all day long 
    Even if you’re not formally exercising, you can still keep active. Choose stairs over the elevator or park at the far end of the parking lot when arriving at appointments and meetings. Home chores like gardening and vacuuming are opportunities to keep your body moving and accomplish tasks at the same time.

Resources for fitness information can be found by visiting the SilverSneakers^® Fitness Program website.

SilverSneakers^® helps older adults take greater control of their health by providing support, education, and access to participating fitness centers. Many health plans offer SilverSneakers to people who are eligible for Medicare or to group retirees. 

To learn more about personal care for help with physical activity or tasks of daily living, contact us today.

View our website today for more useful information.

http://blog.bayada.com/cares/healthy-aging-10-tips-for-getting-fit

Caregivers Take Care of Yourselves

Caregivers Take Care of Yourselves

By CHRISTINE COWGILL | Published: JUNE 10, 2014

This article was graciously provided by Christine Cowgill MS, CRC

There is nothing more rewarding and sometimes more frustrating than caring for your loved one who is sick or dying. Even the best and most patient caretakers need to make sure they take the time out for themselves. Some good suggestions on caretaking and resources for caregivers can be found on the Internet.

In my Facebook page Tips For Caregivers I share the most up to date and relevant information on how to best care for your loved one and yourself. For instance there are tips on how to best handle the stress of being a caregiver, from caregivers.org.

Your level of stress is influenced by many factors, including the following:

•Whether your caregiving is voluntary. If you feel you had no choice in taking on the responsibilities, the chances are greater that you will experience strain, distress, and resentment.

•Your relationship with the care recipient. Sometimes people care for another with the hope of healing a relationship. If healing does not occur, you may feel regret and discouragement.

•Your coping abilities. How you coped with stress in the past predicts how you will cope now. Identify your current coping strengths so that you can build on them.

•Your caregiving situation. Some caregiving situations are more stressful than others. For example, caring for a person with dementia is often more stressful than caring for someone with a physical limitation.

•Whether or not support is available.

Steps to Managing Stress

1. Recognize warning signs early. These might include irritability, sleep problems, and forgetfulness. Know your own warning signs, and act to make changes. Don’t wait until you are overwhelmed.

2. Identify sources of stress. Ask yourself, “What is causing stress for me?” Sources of stress might be that you have too much to do, family disagreements, feelings of inadequacy, or the inability to say no.

3. Identify what you can and cannot change. Remember, we can only change ourselves; we cannot change another person. When you try to change things over which you have no control, you will only increase your sense of frustration. Ask yourself, “What do I have some control over? What can I change?” Even a small change can make a big difference. The challenge we face as caregivers is well expressed in the following words modified from the original Serenity Prayer (attributed to American Theologian, Reinhold Niebuhr):

“God grant me the serenity to accept the things I cannot change,

Courage to change the things I can, and (the) wisdom to know the difference.”

With the proper information and resources to help you manage your caregiving situation as well and the support from family, friends and professionals, the care taking experience can go from burnout to quality care for you and your loved one.

Christine Cowgill MS,CRC is the author of Soul Service: A Hospice Guide to the Emotional and Spiritual Care for the Dying (Balboa Press: 2013). Christine seeks to make a positive social change in the area of end-of-life care through raising awareness and increasing mandatory training for our upcoming physicians and nurses in the areas of palliative, emotional and spiritual care to the dying. For further information visit www.soulservice.info  and her Facebook page Tips For Caregivers for information on all aspects of care for yourself and loved one.

ParentYourParents.com ~ Helping You Help Your Aging Parents