New York Elder Law Attorney Blog

Last week state legislators proposed New York Medicaid changes which would eliminate the financial involvement of local county governments--a state take-over of the program. However, this change would do nothing to curb the overall costs of the program. Lawmakers explain that reigning in Medicaid costs remains a top priority, and so additional alterations to the program are likely. Many observers are calling for tighter enforcement rules to root out fraud. Stricter enforcement of the program will likely target medical care providers who seek to collect money, but these changes may also affect individual residents who are working through the New York Medicaid application process.

An editorial in last Friday's Albany Times Union called upon the legislature not to go "soft" on Medicaid users. Recent problems of fraud in institutions serving those with developmental disabilities were used to highlight the current problem with the program. Some observers believe that homes for those who are unable to live independently because of age or disability are the site of the clearest patterns of excessive Medicaid utilization. Several years ago the New York Commission on Quality of Care and Advocacy for the Mentally Disabled noted that Medicaid billing for these services were "costly, fragmented, sometimes unnecessary, and often appeared to be revenue-driven, rather than based on medical necessity."

Senior care advocates believe that many disabled seniors find themselves in need of dental care, hearing aids, and similar basic services only to be shuffled to alternative medical appointments not of their choosing or tailored to their need. These advocates claim that Medicaid changes are necessary to correct the disconnect between needed services and the ones actually provided. On top of the programmatic problems, the state's Long Term Care Coalition noted that the Health Department lacks the resources to oversee these adult homes properly. The state body struggles to ensure that nursing homes and senior living facilities are abiding by state rules and regulations. The quality of elder care suffers as a result.

Together these issues suggest that far too many local seniors fail to receive the care that they need. To ensure that one's quality of life remains high in the golden years, local residents should take steps as early as possible to prepare for the help they might need. Our New York elder law attorneys work with community members on these issues, helping them apply for Medicaid, shield assets with a Medicaid Asset Protection Trust, chose appropriate long-term care insurance, and otherwise take steps to protect themselves if they need extra assistance.

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Earlier this month the AARP released a new national scorecard measuring the quality of long-term care and support services provided by each state. The data is a clear reminder of the often drastic inequalities in senior care. As our New York elder law attorneys know, not all long-term care options are alike. The well-being and life satisfaction of residents at one location is often drastically different than of residents at others. The quality of the facility where a community member ends up if they ever need these services often depends on how much long-term care planning they have conducted.

The AARP scorecard analyzed the quality of services for the elderly and physically disabled on twenty five different criteria. Unfortunately, the data does not paint a flattering picture of the services and support offered in our state. New York ranked 41st in overall long-term care quality when compared with the rest of the country. The state was near the bottom of the pack in preventing the development of bed sores (a common indicator of neglect) and was found to be one of the worst at offering support for at-home family caregivers.

Professionals have repeatedly found that residents experience a better quality of life the longer they are allowed to stay in their own home without moving into a nursing facility. However, this data reveals that New York is dead last when it comes to the total percentage of home health patients. In other words, more than in other parts of the country, local seniors are forced to move into nursing homes because they are unable to secure the assistance they need while staying in their own home. As a New York Times editorial on the scorecard noted, "this is an ominous statistic given the drive to move larger numbers of people out of institutions and into community-based care."

The state's disappointing performance on these long-term care measurements should act as even more motivation for local residents to take their future into their own hands. For residents who plan ahead, steps can be taken to guarantee that resources will be available to provide high-quality long-term care. Our New York elder law attorneys can share information on options such as long-term care insurance which ensures that funds will be available for at-home care to allow one to age in place. Even if long-term care insurance is out of reach, other strategies may be available to help local residents position themselves to avoid ending up in an underperforming institution.

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The New York Medicaid application process can be a confusing and time-consuming experience. A large number of local residents can expect to go through it at some point in their lives. The latest figures suggest that one in four New Yorkers get some form of Medicaid, and nearly one million residents have been added to the program in the last ten years alone. Professional assistance with the application process is always advisable to ensure mistakes are avoided, the procedure is expedited, and asset-saving strategies are employed. Our New York elder law attorneys have worked with residents on these matters for decades.

Applying for Medicaid and planning for potential long-term care is made even more complicated by the fact that lawmakers threaten to make changes to the program on a seemingly endless basis. Yesterday the Albany Times Union reported that even though the state legislature is not in session until January, many officials floated the idea this week of a state take-over of the Medicaid program from local counties. As it currently stands, the federal government pays for fifty percent of Medicaid costs, the state pays for twenty five percent, and local counties pay for the remaining twenty five percent. New York is unique in its current structure in requiring county governments to pay for part of the costs. Only a handful of states across the country require local governmental bodies to contribute.

However, a new two percent property tax cap will make it considerably harder for counties to pay their share of Medicaid expenses without cutting other services like police patrols, veterans' program, and road maintenance. As one state lawmaker explained, the property tax cap combined with rising Medicaid costs places localities in an untenable position with an unsustainable program. Governor Andrew Cuomo has also made a push for statewide Medicaid savings. The Governor created a Medicaid Redesign Team which is working on strategies to streamline state and local Medicaid responsibilities. However, some advocates worry that shifting the burden entirely onto the state does nothing to solve the underlying problem of rising costs. They worry that cuts to the program will still need to be made, including changes to qualification requirements.

It remains unclear if any of these Medicaid changes will become law, and, if so, what that will mean for residents. In any event, it is increasingly important for local residents thinking about their long-term care to meet with a New York elder law estate planning attorney to learn what options are available. With smart planning, residents can often avoid the need for Medicaid assistance at all, or at least ensure that their assets are protected from the requirement that they be spent down to qualify for Medicaid.

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A Medicaid Asset Protection Trust (MAPT) is one of the best tools available for seniors who do not have long-term care insurance to protect their assets from the staggering cost of nursing home care. This weekend our New York elder law attorney, Bonnie Kraham Esq., had a story published in the Times Herald-Record where she explained the value of this trust for local residents. The article highlighted the specific ways that a MAPT can help local seniors save assets for their family and dispelled misconceptions that some have about creating the trust.

A MAPT is a legal entity that a resident creates with the help of a professional to protect assets from being consumed in order to pay for long-term caregiving costs in the future--usually nursing home care. To create the trust, a resident transfers assets (such as the family home) into the separate legal entity and names someone other than themselves or their spouse as trustee to manage the assets in the trust. The senior may then be able to keep those assets down the road while still qualifying for Medicaid assistance if needed to pay for nursing home care.

Contrary to some misperceptions, local seniors who create a New York Medicaid Asset Protection Trust do not forever "lock up" all of their assets or lose the power to alter what happens to their property. The lifestyle of the senior who creates the trust is usually unaffected, because they still receive pension checks and Social Security checks directly, and they retain the exclusive right to use their home just as before while keeping their home tax exemptions. These trusts are irrevocable, but New York law actually allows the trust to be revoked with written consent of all involved parties. In addition, the individual who creates the trust can amend it to change the beneficiaries at any time.

Medicaid has a five-year "look back" period which makes it important for all residents to contact a New York elder law attorney as soon as possible to discuss this option. So long as five years has passed since the creation of the trust, the assets within the trust will be completely protected. However, even if nursing home care is needed within five years of the trust's creation, a senior gets credit for the time that has accumulated. Therefore, while an early start is beneficial, no senior should put off the creation of a MAPT because of fears of being too old.

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While it slipped under the radar this year for many families, the first Sunday after Labor Day is Grandparents Day. As explained this week in the Daily Local, the holiday has been the topic of a presidential proclamation every year since 1978. More recently it has been used as a time to raise awareness of the continuing needs of many grandparents in nursing homes and the importance of helping our elders conduct long-term care planning. Considering that the majority of area seniors remain concerned about their future quality of life, our New York elder care attorneys know that all occasions are good ones to discuss these long-term care issues.

The non-profit association which champions Grandparents Day each year explained how the group has been working to help families take steps that will keep their elders in their own homes, instead of nursing homes. Efforts to transition away from nursing home care are growing in popularity nationwide. Our New York elder law estate planning lawyers have long recognized that most area seniors would prefer to "age in place," receiving the additional care that they need without being forced to move into a nursing home or other long-term care facility.

However, the financial realities of these situations often mean that it is only those who have taken steps to prepare for this time in their lives that ultimately have the freedom to stay at home. For example, residents who visit a professional early enough to discuss these matters often decide to invest in long-term care insurance (LTCI). This insurance can ensure that the resources will be available when necessary to pay for at-home care when a senior is in need of extra assistance with day-to-day tasks. It is difficult to put a price tag on the peace of mind that comes with knowing one has done everything in their power to ensure that their quality of life will remain as high as possible no matter what the future holds.

When learning about their options in this area, some resident decide to combine LTCI with a Medicaid Asset Protection Trust (MAPT). The MAPT is a tool that protects assets in the event that public assistance will be needed to cover long-term care costs. Combining LTCI with a MAPT often allows one to purposefully underfund the insurance plan (at considerably savings) while protecting assets in the event that nursing home care cannot be avoided. All local residents are encouraged to talk with professionals about these matters to determine what is best for them. There is not a one-size-fits-all approach to these issues, but it is undeniable that some planning is infinitely better than none.

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The majority of community members will need some type of long-term care in their lives. Recent research from the U.S. Department of Health and Human Services shows that as many as 75% of all seniors will eventually require extended caregiving. Our New York elder law attorneys have spent years helping local residents prepare for this reality. A growing number of families are becoming cognizant of the importance of having a long-term care plan. However, much more awareness still needs to be raised before all those who likely need to prepare for this care actually do.

As reported in Market Watch last week, a recent poll suggests that discomfort about the aging process is at the root of many American's failure to properly plan for their long-term well being. The latest data shows that more than half of residents over 50 years old report being worried about paying for long-term care, and only 16% feel confident that they have an adequate plan in place. While few Americans are comfortable with their planning, many still fail to take the preparatory steps necessary to bring peace of mind.

Unfortunately, a "hope for the best" attitude is prevalent among some who are reluctant to plan ahead for this care. One individual involved in the survey explained that the new data "shows that fear and wishful thinking paralyzes many people age 50 and older from making contingency plans that we believe can significantly enhance the quality of their final years and in many cases, conserve their finances." That fear and wishful thinking may be why there is disconnect between the average individual's projections about their own need for this special care and the statistical reality. While government data shows as many as 75% of citizens will need long-term care, less than 50% of survey respondents thought that they would personally need the help down the road.

Our New York elder law estate planning lawyers know that a combination of fear about the aging process and unfamiliarity with preparatory options prevents many from creating a strong long-term care plan. Sadly, many of those who have the most to gain from visiting with a professional to learn about their options fail to do so. This is misguided. As the survey author advised, "instead of hoping for the best, we can all take steps aimed at securing the best possible lifestyle within our means, should we ever need long-term care."

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The economic conditions of the past few years have placed many families in difficult financial circumstances. Few demographic groups have been spared, and our New York elder law attorneys know that the situation has affected many seniors in our area. Echoing that trend, a forthcoming article in The Elder Law Journal explains how there has been a sharp increase in the number of elderly community members filing for bankruptcy.

According to the latest data available, those over sixty five years old account for seven percent of all bankruptcy filings. This is a marked increase from rates over the past two decades. For example, senior citizen bankruptcies represented only four and half percent of the total in 2001 and roughly two percent in 1991. The new research on the topic found that medical debt was one of the most commonly cited reasons for the filings by these community members. The often staggering cost of care required by seniors makes it a virtual necessity for all local residents to conduct proper New York long-term care planning to ensure that they are not financially devastated by these medical and caregiving bills.

The new research on elderly bankruptcies found that one of the main reasons why seniors find themselves facing financial struggles is an unwillingness to ask others for aid with fiscal questions. All local seniors who are worried about their financial well-being should remember that assistance is available. An experienced New York elder care lawyer is able to help local families plan ahead for long-term medical care. This preparation provides the peace of mind that comes with knowing that one's finances will be protected regardless of what the future holds.

For those who plan ahead, there are often many options to protect family assets from long-term care costs. Those who conduct planning early enough may find that long-term care insurance is a viable option to protect themselves. Not only does this insurance protect assets and income, but it also pays for at-home care so that seniors can maintain their preferred lifestyle for as long as possible. Even if this insurance is out of reach, other legal tools--such as a Medicaid Asset Protection Trust--can be used to protect family assets while ensuring that care will be available when necessary.

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Local residents who are diagnosed with Alzheimer's or other cognitive diseases face a series of mental, medical, and emotional challenges. Our New York elder law estate planning attorneys work with many families who have loved ones battling these disabling diseases. Unfortunately, many area residents fail to take appropriate preparatory steps before a victim's mental capacity is lost. As a result, these families often face difficulties with inheritances and have challenges defining who is in control of legal, financial, and medical issues. Many also struggle to protect the senior's assets from long-term care costs.

Advocates are working to raise awareness of these issues to help the thousands of local families who are forced to deal with the situation each year after a dementia diagnosis. For example, the New York Chapter of the Alzheimer's Association began programs this week to support September's designation as World Alzheimer's Month. The local organization is sponsoring a variety of activities to raise money for research, support those battling the disease, and educate local families on the importance of conducting New York Alzheimer's planning. The local advocacy group is offering care consultation services to help families who face many challenges following an Alzheimer's diagnosis. The organization explained that "the goal is for each family to develop a better understanding of the disease, make a plan to secure needed care, and develop strategies for the best possible symptom management and communication."

For area community members, the necessary planning usually involves a visit to a New York elder law estate planning attorney to ensure that all the legal affairs are in order. Timing is important, because victims of these diseases often lose the ability to communicate. It is vital to work through these planning issues in the earliest stages of the disease.

A legal professional will be able to help the family with estate planning issues like updating inheritance documents, drafting a Power of Attorney, and designating a Health Care Proxy. In addition, an attorney that possesses expertise in elder law will be able to advise the family on how to apply for Medicaid benefits and to protect assets from possible long-term healthcare costs. One of the most common ways that assets are protected is through the use of a Medicaid Asset Protection Trust. These trusts often involve the designation of adult children as "trustees" to manage the trust. The individual's assets are then placed in the trust to protect them from the requirement that they be "spent down" before the senior qualifies for Medicaid assistance. Many Alzheimer's patients spend years needing close medical care. That care often costs over ten thousands of dollars a month, and so planning ahead for that need is essential.

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Earlier this year Congressional hearings were held on the often forgotten problem of elder financial exploitation. Federal officials are still considering a variety of legislative options to protect victims of these crimes and hold wrongdoers properly accountable. Our New York elder law attorneys know that many residents in our area fall victim to predatory actions that often deplete resources built up over a lifetime. The problem takes many forms, from identity theft and scams to manipulation by trusted caregivers. Surprisingly, much financial abuse is perpetrated by friends and family members who exploit the senior's vulnerability for personal enrichment.

While legislative actions may be helpful to better protect seniors from this exploitation, the first line of defense is proper individual financial preparation. Taking proactive steps to minimize the risk of being taken advantage of is the best way each individual resident can protect themselves. For example, a comprehensive story at TBO News explained this week that identity theft can usually be prevented if simple steps are followed. This includes refusing to give personal information over the telephone, deleting unsolicited emails that ask for personal information, and not carrying Social Security cards and multiple credits cards at the same time. Additionally, seniors should be sure to shred personal mail, stop mail before going on vacation, be cautious with online shopping, and frequently review financial statements.

While identity theft is a common fear, most seniors are much more likely to be financially exploited by family and friends. To guard against this mistreatment, local advocates agree that it is important to have a New York elder care plan in place so that trained eyes are aware of your financial situation. Beyond that, simple steps can help to limit one's risk of being victimized. It remains important never to give blank checks for others to fill in the amount, sign complicated papers that you don't understand, or give others unlimited access to financial information. In addition, seniors should always work with their banks to control who has access to funds.

It is always preferable for local seniors to prevent the exploitation before it occurs. Our New York elder law estate planning attorneys are able to help residents put plans into place that can act as a layer of protection against unwanted financial tampering. There is no better way to feel protected than by building strong relationships with professionals who handle your financial affairs. No matter what, seniors who are victimized in any way should contact local law enforcement officials. New York elder financial abuse is woefully underreported. This makes it difficult for advocates to identify the scope of the problem or take steps to help those who have been hurt.

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