New York Elder Law Attorney Blog

Earlier this year a featured article in Atlanta Magazine offered a uniquely detailed and accurate portrait of what it is really like to help an ailing parent or loved one as their heath deteriorates. Entitled, "The Long Goodbye," the article shares the author's own story of heartbreak, worry, stress, financial loss, and confusion while caring for his ailing father. Each New York elder law attorney at our firm understands that it is often helpful to hear real, individual stories about the aging and caregiving process. Discussing numbers--assets saved, taxes avoided--is necessary, but at the end of the day this process is very much about emotions and family values.

The author explains that he thought his father was going to die in 2001. The elderly man had fallen while trying to get the mail, hitting his head hard on the ground and temporarily losing consciousness. The man then skinned his knees as he crawled back up his driveway to the front door of his house. It was that incident that prompted his family to take him to the hospital where he was diagnosed with a deteriorating spine. Not only that, but doctors also found prostate cancer. A risky operation was undertaken, and the family was warned that the man was likely in his final days.

However, he was not actually in his final days.

Similar to the experiences of many local community members, the elderly man persisted. For the next eleven years he was shuttled from care facilities, hospices, and other locations as those involved struggled to find the best fit for him. Our New York elder law attorneys have worked with many clients who have similarly been confused as to what long-term care options are best for their loved one.

The eleven years of care took its toll on the family finances. The author explained, "Daddy's long goodbye has drained his retirement income and life savings of more than $300,000. Where's the money gone? Assisted living, mostly. Of course, that amount doesn't account for his medical bills, most of which have been paid by Medicare and insurance policies that were part of his retirement."

The author admits that he and his sister were completely unprepared to deal with their father's deterioration. They were not familiar with long-term planning options, had not spoken with an elder law attorney, and did not know where to begin to get him the care he needed. The author warned others that while it may not be comfortable to talk about, the benefits of figuring some of these details out ahead of time is absolutely essential.

See Our Related Blog Posts:

New York Ranks Poorly on AARP Long-Term Care Scorecard

Do Not Let Long-Term Care Destroy Your Retirement Planning

Elder financial abuse is fast becoming a national crisis. That is the message that a New York geriatrician and social scientist is spreading after conducting extensive scientific investigations into the extent of fraud and financial exploitation among local seniors. The doctor is encouraging friends, family members, caregivers, New York elder law attorneys, and others to keep a close eye out for the signs that this abuse might be occurring among seniors that they know.

As reported in the Centre Daily Times, the doctor's latest work suggests that literally millions of seniors are victimized financially each and every year. Yet only a fraction of the instances of abuse ever come to the attention of authorities--only one in forty four, according to the report. In even fewer cases are the wrongdoers held accountable for their conduct. Previous work by this same team of researchers also found that those seniors who had been abused financially saw similar damaging effects on their physical well-being. The groundbreaking work revealed that mortality rates of elderly victims of financial abuse were significantly higher than for those who had not been abused. Suffice to say, this mistreatment has profound effects on the lives of victims and all efforts to limit the problem must be taken.

Yet, there is a long way to go before the mistreatment is stamped out. According to the latest research at least 2.5 million seniors are victims of financial abuse each and every year. Even then, that number may be a significant understatement. For one thing, it was reached mostly via self-reporting. Many seniors might hide their situation out of fear or embarrassment. Additionally, the research team noted that seniors who were suffering from a severe rate of mental decline were not polled in the survey. Yet it is that very group which is at the highest risk of being victimized by unscrupulous individuals willing to take advantage of them for personal financial gain.

Visiting a New York elder law attorney before a loved one with cognitive mental diseases, like Alzheimer's, loses the ability to communicate is essential. The professional will be able to provide an extra set of eyes on the senior's books which may help catch irregularities or signs of financial abuse. Beyond that, having an elder law estate plan put in place will help keep the senior's wishes fulfilled, even if they lose their mental capacities. Substitute decision-making documents will also be crafted to provide for the best interests of the elder as the disease progresses. These include creation of a Power of Attorney and Health Care Proxy. All of this will help avoid costly, timely, and stressful guardianship proceedings through the court system.

See Our Related Blog Posts:

Proper Senior Care Planning Needed to Prevent Elder Financial Abuse

Authorities Often Act Too Late to Prevent Elder Financial Abuse

Every New York elder law estate plan should likely include a Power of Attorney and Health Care Proxy. These documents allow another person to handle a variety of legal, financial, and medical affairs on your behalf in the event of disability. Our New York elder law attorneys know that preparing for all possible contingencies is the main purpose of this planning, and so inclusion of these documents remains essential.

Some residents are less familiar with the importance of these decision-making tools and may assume them to be unnecessary in their particular case. They may believe that their friends or family members will step up and handle affairs appropriately without the need for formal legal documents. Unfortunately, that assessment is misguided because very often family disagreement arises among these individuals under the stress of dealing with the disability--setting the stage for conflict without prior delegation of decision-making power. The director of a local public aging services center explained that "the last thing you want is if you age and lose capacity, to become a pod in a power struggle between your kids or your grandkids." On top that, even if one's family members do not disagree on any financial or medical issue, the law will not automatically grant these powers to a certain friend or family member. In many cases, the disability requires court intervention to appoint a guardian which is a situation that should always be avoided.

Failure to provide this legal clarity ahead of time can have wide ranging effects. For example, KFBB News reported late last week on one man who is facing felony kidnapping charges after allegedly taking his 92-year old mother out of her long-term care facility and bringing her into another state without permission. The man was not his mother's Power of Attorney. The family was confused about the local elder care laws, and the man assumed he had the right to move his mother. He didn't. He is now awaiting extradition to face possible criminal sanctions for his conduct. It is likely that the man would not be facing any charges at all had a Power of Attorney been drafted.

While kidnapping charges in these circumstances are rare, all families have much to gain from ensuring that there will not be legal confusion in the event of a disability. In addition, it is important to have professional help with the creation of these legal documents. Experienced attorneys can explain what specific powers are useful to include. These are powers that otherwise might be forgotten and left out, such as the right to change beneficiaries on IRA's, annuities, and insurance policies, to create a trust, or make gifts.

See Our Related Blog Posts:

Understanding the Rights of Residents living in Nursing Homes

Dealing with an Alzheimer's Diagnosis

Designating a Health Care Proxy is a vital part of a New York elder law estate plan. Earlier this month The New Old Age, the New York Times blog, discussed efforts by one local family to enact legislation to offer an "enhanced" Health Care Proxy to aid those who are taking care of elder loved ones.

The effort is being spearheaded by a New York nurse who is helping to care for her 91-year old mother. As the woman discovered, without proper legal documentation it is often difficult for concerned family members to act as a health care advocate and decision-maker for their older relatives. For example, the woman got the idea for a change in the law after having trouble dealing with her mother's mail-order pharmacy company. The pharmacy had sent a different color pill than normal, and the daughter wanted to check that the change was intentional. However, the company would not answer even basic questions without the consent of the woman's mother, because laws protecting patient privacy are strict.

The woman's mother suffers from Parkinson's disease, is hard of hearing, and talks slowly. However, she remains mentally sharp and is not legally incapacitated. Family members often have difficulty assisting older adults with financial and health case decisions unless the individual is officially deemed incapacitated. As the nurse leading the lobbying effort explained, "Family members and others should be able to help frail seniors or younger people navigate the health care system without abandoning them to its complexities or taking over as guardians."

The enhanced proxy would allow seniors to designate someone--such as a family member, friend, or doctor--to help with health care decisions at any time. The senior would retain ultimate control and would have the power to revoke at any time.

Continue reading "Elder Care Advocate Lobbying for Enhanced New York Health Care Proxy Law" »

Second marriage planning always presents families with unique issues to consider regarding planning for their future. Those concerns are often made more urgent when the marriage occurs late in life. When local residents with children enter into one of these marriages it is particularly important to contact a New York elder law estate planning lawyer for assistance.

Last week the New York Times blog, The New Old Age discussed the myriad of issues that arise with late-life marriages. A common theme involves the amount of intermingling that spouses want between each of their separate assets and income during their lives, in case of divorce, and after death. For example, how much of one spouse's assets can be used to pay for the medical bills of the other spouse? Medicaid concerns must also be factored into the planning. Rules usually dictate that assets of both spouses are considered when one is attempting to qualify for Medicaid. An elder law attorney should be consulted so that these issues can be discussed and couples can strategize.

Late-life marriages may also have effects on Social Security benefits and taxes. The ability of one spouse to draw benefits based on the former spouse's earnings could be altered in these cases. Remarriage before the age of sixty usually cuts off that Social Security benefit. Couples must also decide whether to file taxes jointly or separately. The decision determines what tax bracket the couple falls into and may shift tax mistakes of one spouse onto the other.

Those in late-life marriages must give careful thought to how it will affect their property distribution upon their death. An older spouse who has specific plans about how to leave his or her estate must recognize the role that their new spouse may play in that decision. Surviving spouses almost always have the option of taking an elective share of the other's estate unless other arrangements are made beforehand. A prenuptial agreement may be important in those situations.

Continue reading "Plan Ahead for Late-Life Marriage Issues" »

The onset of medical conditions that affect brain function like dementia or Alzheimer's often act as triggers for local residents and their families to visit a New York elder law attorney. As most are aware, these illnesses affect millions of individuals across the country. The brain conditions result in memory-loss, reduction in learning ability, and reasoning problems. Obviously these illnesses pose a serious threat to an individual's ability to properly manage their affairs, and caregivers are often required to help with day-to-day activities.

While conditions like dementia are rarely found in anyone less than 65 years of age, there are a few lesser known illnesses that affect brain function and occur in younger individuals. Last month the New York Times profiled one of those forms of dementia, known as primary progressive aphasia (P.P.A.). The syndrome often strikes those in their 50s. Its rarity and the age at which it occurs often cause doctors to misdiagnose the condition as depression, anxiety, or even a stroke.

Unlike Alzheimer's or dementia, P.P.A. does not initially affect memory but instead affects an individual's communication abilities. An expert on the disease explains how P.P.A. damages the part of the brain that is used in word-finding, object naming, syntax, spelling, and word comprehension.

The wife of one 55-year old sufferer from P.P.A. explains her husband's impairments, noting that "he can no longer punch in the numbers to operate the garage door or the microwave or the remote for the TV. He might open the car window, then not know how to close it."

While communication impairment is the primary problem caused by P.P.A., eventually patients suffer other deficits, like memory-loss, various cognitive abnormalities, and even motor problems. It is for those reasons that the article concluded by recommending that those who may be suffering from P.P.A. visit an elder law attorney to ensure that their family's financial affairs are in order.

Continue reading "Primary Progressive Aphasia Remains Little-Known Form of Dementia" »

Unfortunately current economic hardships may exist more acutely for the LGBT elder community because of a lifetime of federal law discrimination that has affected their financial security and health care options. Of all the so-called financial safety nets, including Social Security and retiree health insurance benefits, the harshest effects on aging LGBT Boomers is Medicaid. To be eligible in New York for state nursing home assistance, certain asset and income level requirements exist whereby qualified applicants must be deemed impoverished.

New York State Medicaid allows the spouse of a person receiving Medicaid - "the community spouse" - to keep certain assets including the family home to protect against total impoverishment. Because marriage rights are not granted to same sex couples in New York, they cannot take advantage of this provision.

On the other side of the coin, the inability of same sex couples to marry in New York offers a distinct Medicaid planning advantage in later years. If you are in a same sex partnership and wish to plan ahead five years to protect your jointly owned home and life savings from nursing home costs, and cannot obtain long-term care insurance for any reason, you may both establish a Medicaid Asset Protection Trust for one other. Legally married couples may not name each other as the trustee in a MAPT. Same sex partners, however, are able to name one another as each other's trustee and therefore do not have to go outside of the relationship to put someone else in charge in order to protect assets. A New York elder law attorney who has familiarity with the underserved legal needs of the LGBT community can best advise whether or not a MAPT is a viable financial solution in a given situation.

by A.K. Lehmann, ABA Paralegal
Lehmann & Lehmann Legal Communications

Each county in New York State demands a unique set of paperwork when applying for Medicaid assistance to pay for nursing home care. While this is subject to change in April when the New York State Department of Health will institute statewide uniformity application rules, right now the rigid documentation requirements by individual county can often slow down the process - even when a family member may need immediate transfer into a residential health care facility. In order to prevent any delay, it is absolutely necessary to gather all relevant documentation before the application is actually submitted. (See below document list.)

No matter what New York State county you or your family member lives in, Medicaid requires documentation from five years ago. Be prepared to gather, research and request paperwork dating back to 2006. There are absolutely no exceptions. An application will be denied without all of the requested paperwork. Often applicants request that a Medicaid application be incompletely submitted, hoping that the documents that they provided will be enough.

"There is no 'let's make a deal' with a county's Department of Social Services. Even if clients have submitted two or three years' worth of paperwork, but omit one year, I still have to explain them that without all of the necessary documentation, their Medicaid application will be denied," says Elizabeth Schalk, Ettinger Law Firm's experienced Medicaid supervisor.

As New York elder law attorneys with offices in over eleven counties, Ettinger Law Firm is familiar with many application requirements of statewide Department of Social Services offices. Schalk is well-apprised of how county application processes differ and what is required in order to improve the likelihood of a speedy process of individual Medicaid applications.

Please see this general list of documentation that may be required for your New York State County's Department of Social Services when applying for Medicaid for nursing home care:

1.Original birth certificate, passport or Social Security confirmation.
2.A copy of naturalization papers if applicant was not born a U.S. Citizen.
3.A Social Security Card.
4.A copy of Medicare and secondary health insurance cards.
5.Verification of all life insurance policies and their face and cash values.
6.If a spouse is deceased, a copy of his/her death certificate.
7.If the applicant is married, a copy of the marriage license.
8.If the applicant is divorced, a copy of the divorce decree.
9.A copy of all burial plans and prepaid funeral arrangements.
10.Verification of Social Security benefits received
11.If the applicant still owns a home, a copy of the deed.
12.If the home has been sold on or after January 1, 2006, verification that the home
as sold at fair market value, with a statement from a real estate agent.
13.Financial statements for all investment accounts in the applicant's name from January 2006 until the present, including all those closed or transferred.
14.All pages from bank statements from January 2006 until the present, along with a verification of Origin of Deposit (where the money came from) for any transaction of $1,000 or more and any withdrawals for any transaction of $1,000 or more. Verification of the gross amount of a pension received (such as a current award notice or check or statement from the source or a payor)
15.Federal income tax returns for the year 2006 through the present, including copies of all schedules and attachments. If a return hasn't been filed for any of those years, a NO FILE letter must be provided from the IRS.

When applying for Medicaid benefits, the help of an experienced New York elder law attorney is invaluable.

This post was written by A.K. Lehmann of Lehmann & Lehmann Legal Communications

by A.K. Lehmann, Paralegal.

More and more Americans are caring for an older friend or relative. According to the National Alliance for Caregiving and AARP, 43.5 million serve as caregivers to their elders, a 28% increase from 2004. Because of the tough economic climate of recent years - including the high unemployment rate - an increasing percentage of those are receiving compensation for providing care to a relative or friend.

This trend is predicted to rise due to the 2006 change in Medicaid law that makes it harder for people who qualify to give away assets. (A New York State Medicaid attorney familiar with the changing laws can assist in creating trusts that may make it possible to give away assets and still qualify for benefits.)

When caregivers make financial sacrifices it is often appropriate that they receive compensation.

There are various ways to pay relatives or friends with an:
• Hourly wage,
• Annual gifts or lump sum payments, or
• Larger inheritance.

Families must consider estate planning implications, Medicaid eligibility rules, and tax consequences.

Under federal law, when an annual compensation exceeds $1,700., an employer and employee each owes federal payroll taxes of 6.2% for Social Security and 1.45% for Medicare. There are also state taxes. (For more information see IRS Publication 926 "Household Employer's Tax Guide.)

Because of these reasons, elder law attorneys advocate the drafting of a written agreement called "a personal care contract" - before services are rendered.

A written agreement is especially prudent if the care recipient may eventually need to rely on Medicaid. Without an employment contract, Medicaid would consider payments to the caregiver as an attempt to hide assets - a real "no-no" for Medicaid administrators who carefully review applications.

Caregivers and recipients are urged to disclose any compensated caregiving arrangements to family members. New York elder law attorneys see family conflicts and even estate litigation as a result of hidden arrangements.

Source: Wall Street Journal, 12/10/10. "Should You Pay a Relative to Take Care of Mom?" Anne Tergesen

by A.K. Lehmann, Paralegal.

A health care proxy and living will are a part of a comprehensive elder law estate plan.

A living will describes certain life prolonging treatments which indicate preferred medical care in the event you either suffer from a terminal illness or you will become in a permanent vegetative state. It usually requires certification by a doctor. The health care proxy gives someone else the authority to make health care decisions for you in the event you are incapacitated. Neither of these documents, however, addresses personal and emotional desires or spiritual beliefs around the end of life process.

Aging with Dignity, a privately-funded, non-profit organization which advocates for the elderly and their caregivers, developed a legal advance directive document that compels you to think about situations which arise at the end of life.

The Five Wishes document prompts you to answer questions about:
• The person who you want to make care decisions for you,
• The kind of medical treatment you want or don't want,
• How comfortable you want to be, and
• What you want your loved ones to know.

After completing the questions, the document must be signed and witnessed. After that, The Five Wishes document meets the legal requirements for an advance directive in New York State. There are other requirements if the document is completed in a mental institution (See N.Y. Pub. Health Law Section 2981 (b)).

It is available for downloading on the Aging with Dignity website for a fee.

A New York elder law attorney can assist in making sure all of the legal documents you need are in an individually designed and comprehensive elder law estate plan. Having an experienced advocate for end of life issues may be desirable and even necessary. It is, after all, a process that may be the most important and complex one of you and your families' lives. Anything that you can do to make it easier for loved ones will be greatly appreciated - perhaps even more than leaving behind a well-planned financial legacy.

Part I of a Two Part Series

By A.K. Lehmann, Paralegal

The End of Life Counsel Bill (A 7617/S 4498), recently passed in the New York State Legislature, requires doctors caring for a terminally ill patient to offer information and counseling on available options for palliative and end-of-life care. This new obligation to inform patients of their medical care options is based on the fundamental right of "informed consent."

"End of life" treatments include:
• Hospice
• Pain Management, and
• Palliative Sedation.

The Senate explained the need for doctors to initiate this conversation:

"The lack of communication with respect to basic end-of-life options is a continuing problem. Patients often do not know what options for palliative care and pain management are clinically and legally available to them at the end of life. Patients must be empowered to control his or her own medical care decisions by having access to full information."

Patients may accept or decline the offer to "end of life" counseling - but at least now they, and their family members, do not bear the responsibility for beginning the process of what may be the most difficult and important decisions of their lives.

Furthermore, studies show that earlier referral to hospice and palliative care results in higher quality of life and greater patient and family satisfaction. By making comprehensive medical care information available to patients earlier on in the process of dying, patients and their family members will have greater access to a higher quality of care.

The New England Journal of Medicine reported yesterday that lung cancer patients who receive palliative care actually live three months longer than similar patients not receiving such care.

New York's Hospice and Palliative Care Information Act (PCIA) was supported by David Leven, Executive Director of Compassion & Choices, "Now, at last, patients nearing the end of life will receive an offer to discuss it. Some will decline the offer. Many will accept and use the information to negotiate a death that honors their life and leaves memories of peace and comfort for their loved ones with them at the end. [...] This bill will change the medical culture's imperative to never speak of death and offer any treatment, no matter how remote the chance of success."

The media has taken an interest in this very important health care issue which has come to the fore of our nation's consciousness due to President Obama's health care reform. Vice Presidential nominee and media celebrity, Sarah Palin, made "end of life" counseling rights controversial by relating them to a type of "death panel."

It is important to note that the bill clearly states that patients may decline the offer of information on health care options which will end the discussion.

Recently The New Yorker published an article written by Dr. Atul Gawande that illustrated stories of uninformed patients suffering from endless aggressive medical treatments like chemotherapy, surgery and/or radiation. Gawande attributed this type of care to the medical profession's general inability to muster the courage to discuss imminent death. Without thorough information about medical care options, terminally ill patients are unable to ask critical questions about side effects of treatments and their chances for success.

Last week, Frontline also broadcasted a series entitled "Facing Death." Watchers applauded the producers saying that it is time for Americans to learn how to talk about one of the most important aspects of our lives. "Learning to let go" was the principle advice of those interviewed who were at the "end of their lives." The fourth and particularly poignant episode in the series is entitled, "Talking About the End of Life."

Ettinger Law Firm, as New York elder law attorneys, will keep its clients posted on developments on these emerging "rights to information."

We appreciate your feedback. Please write to us on this blog post.

Next week:
Part II: New Legislation in "End of Life" Care Rights Dartmouth College's Study of "End-of-Life" Care and Finding An Advocate for "End of Life" Planning

Handling day-to-day money matters isn't always the simplest of tasks - even for those with strong financial acumens. Managing the business of a household can also quickly grow into a formidable task. Paying bills twice; overdrawing on checking accounts and succumbing to questionable investments are perils faced by all, but perhaps even more so as one gets older. This is where family becomes important.

Oftentimes adult children assume that their parents have everything "taken care of" and parents think their financial affairs are none of their children's business. New research from the Employee Benefit Research Institute (EBRI) reveals that 51% of adult children have never had detailed discussions with their parents about their income and expenses.

As everyone knows, talking about money is perhaps one of the most unapproachable, emotionally difficult and uncomfortable subjects. Yet avoiding discussing them with aging parents could possibly be disastrous, especially when it comes to making sure that their long term health care needs are planned. Sometimes it helps to seek out a New York elder law attorney after the initial conversation.

Here are some suggestions for breaking the ice:

Remember the goal is not to find out how much money is involved. Instead, this important conversation can begin by asking about their advisors or if there is a contingency plan in place for disability. Sometimes siblings split the fiscal responsibility of aging parents - one oversees the day to day bill paying and the other will manage and/or oversee long term investments/financial advisors.

Authored by A.K. Lehmann, Paralegal

The New York Times published "The Secrets of the Centenarians" in last week's Science Times. The numbers of Americans aged 100 have risen from 38,300 in 1990 to 104,099 in 2009. "Extreme longevity" according to Jane Brody requires some certain skill sets. As part of the two part series appearing in The Times, Brody's colleague interviewed members of the century club. One of them summed up three critical attributes for longevity: resolution, resourcefulness and resilience.

Here in brief, are some answers to the question that centenarians are often asked.

I always put anything disagreeable or bad out of the way. That's the secret of life. Don't emphasize anything that is evil or bad, but get rid of it or rise above it.
-Travilla Demming, 100

I wore heels at my 90th birthday.
-Gladys D'Less, 100

Look for the second part in this week's NYT's Science Times and visit an audio slide show online at www.nytimes.com. As New York elder law attorneys, we counsel members of the century club. It is one of the greatest privileges of this field of law.

Alzheimer's Disease International (ADI), a federation of 73 national Alzheimer's organizations, recently released a report on the economic impact of the disease. In the U.S., there are as many as 5.3 million Americans living with Alzheimer's and every 70 seconds someone in America develops the incurable illness. In 2010, there will be a half million new cases of Alzheimer's. Unfortunately, it looks like the disease is growing exponentially. In 2050, ADI predicts nearly a million new cases every year.

In 2006, Alzheimer's was the seventh leading cause of death in the country. While death rates are thankfully decreasing for heart disease, prostate and breast cancer, Alzheimer's deaths rose 46.1 percent from 2000-2006.

This disease is reaching epidemic proportions and has become a national crisis. Like all terrible illnesses, it discriminates against no one. Long term health costs continue to escalate. Caring for those affected with Alzheimer's and other dementias cost U.S. society a total of $172 billion, including $122 billion in costs to Medicare and Medicaid.

This tremendous strain on the already overburdened state and federal health care costs will only get worse if the U.S. government does not start to invest in substantial research for its cure. Certain evidence-based prevention strategies should be further developed immediately.

Alzheimer's Association is currently working to enact legislation, the "National Alzheimer's Project Office" (S. 3036/H.R. 4689), that will outline a national plan to overcome the Alzheimer's crisis. It will include strategic planning and coordination for the fight against the disease including initiatives for research, care and support.

"We need all Americans concerned about Alzheimer's disease to tell their representatives in Congress and the President to pass the Act [...]," said Robert Egge, Vice President of Public Policy for the Alzheimer's Association.

Families and friends are encouraged to contact their state senators and representatives to show their support for the "National Alzheimer's Project Office" bill (S. 3036/H.R. 4689).
A consultation with a New York elder law attorney is essential to know your rights and to avoid impoverishment if you or a loved one must care for someone suffering from Alzheimer's disease.

The information for this blog post was provided by the Alzheimer's Association. For further information, please visit The World Alzheimer Report 2010.

by Bonnie Kraham, Esq.

Most of us don't want to end our days in a nursing home, and would rather "age in place," so it's important to become familiar with available home health care services.

There are three major ways to pay for home health care: self-pay, long-term care insurance, or Medicaid, which is government provided health insurance for those whose assets have been depleted. Medicare, which is government provided health insurance for the elderly, only has limited community home health care. A New York elder law attorney can help to decide which one is the best option.

In general, "community" Medicaid programs, for home care, do not have a "look-back period," that is, Medicaid does not "look back" to see if any transfers (gifts) were made which would make the person ineligible for a certain period of time. Therefore, assets can usually be transferred before applying for community Medicaid without penalty, unlike the rules for "nursing home" Medicaid.

If you meet the asset and income rules, following is a list of some of the home health care services covered by Medicaid:

Personal Care Aide Program. Agencies, paid by Medicaid, employ aides who give custodial level services based on the Activities of Daily Living (ADL's) - feeding, toileting, grooming, bathing, ambulating and transferring. A patient must need help with at least two ADL's.

Consumer-Directed Program. The services are the same as above but the patient, or adult family member, selects the aides, rather than going through an agency. The home attendant cannot be an immediate family member.

Certified Home Health Aide Services. This program usually covers the cost for 45 days after hospitalization. The aide performs health care under the supervision of a registered nurse or licensed therapist. The covered activities include the ADL's and possibly skilled services such as special meals, and tube feedings if the patient is self-directing.

Lombardi Program. Also referred to as the "nursing home without walls," this is the long-term home health care program, the equivalent of a nursing home level of care. The cost for the care cannot exceed 75% of nursing home costs. Availability is limited. The Lombardi program and other similar programs have a five-year look-back period for any asset transfers which would create a "penalty period," or period of ineligibility for Medicaid.

To find other home health care services, contact your county's Office for the Aging for a list of local providers. Orange County (845-615-3700) or Sullivan County (845-807-0241) and Ulster County (845-340-3456)