New York Elder Law Attorney Blog

Last week the New York Times discussed changes in the nursing home industry that may affect how some local residents conduct elder care planning. In a time when nursing home care is becoming more expensive--and Medicare and Medicaid funding shrinks--many facilities are experimenting with at-home models of care. Our New York elder law attorneys understand that the nursing home is a rarely the location that seniors would prefer to age if they had a choice. Now, however, many health care experts and senior advocates are joining the call and explaining that nursing homes are rarely medically necessary or financially smart.

Instead, more and more resources are being put into advances in home care. Instead of living in an institutional-like facility, the new model essentially uses traveling doctors, social workers and therapists to provide care at the senior's home or adult day-care centers. An at-home senior care program run by CenterLight Health System in New York City now has over 2,500 participating residents. New York State Medicaid program director Jason Helgerson explained that in the past the state "was institutionalizing service for people, many of whom didn't need 24-hour nursing care. If a person can get a service like home health care or Meals on Wheels, they can stay in an apartment and thrive in that environment, and it's a lower cost to taxpayers." It is no surprise then that the state of New York plans to shift upwards of 80,000 Medicaid participants into at-home, managed care models over the next three years.

The Archdiocese of New York--one of the state's largest nursing home providers--recently announced a shift away from nursing home ownership. In the announcement, Cardinal Timothy Dolan explained, "Seniors and others who have chronic health needs should not have to give up their homes and independence just to get the medical care and other attention they need to live safely and comfortably."

Though still early, initial studies suggest that these at-home managed care situations both provide better care and cost less. All those working on New York elder law understand that quality, low-cost care is going to become increasingly prized in the next few decades. The aging of the population will demand a sharp increase in elder care services. It is highly unlikely that the demand can be met by sticking with the brick-and-mortar, old-fashioned nursing home model. In fact, nationwide, over the past six years the total number of nursing homes has actually declined by 350. Right now there are 634 New York nursing homes, a decrease of 15 homes in the last five years.

See Our Related Blog Posts:

Expert Advice Crucial to Avoid Medicaid Penalties for Nursing Home Benefits

Long-Term Care Insurance is Key Medicaid Strategy to Protect Assets & Allow Home Care

Laws change. Elder law and estate planning strategies change. But the basic principles surrounding inheritance planning, disability planning, and preparing for one's golden years have been around for centuries. In a soon to be released book from Harvard University Press entitled Someday All of This Will be Yours: A History of Inheritance and Old Age, author Dick Hartog takes a look at some of those timeless principles that have involved elder law and estate planning over the years.

A recent book review summarized the text by noting that Hartog (a legal historian) examines how "ordinary men and woman arranged for their own care as they aged, and then how their alleged caretakers attempted to use the law to make good on these arrangements." Of course our New York elder law attorneys are immediately drawn to these sorts of topics as helping local families make these arrangements is a large part of our practice today. The new Hartog book looks at dozens of elder law cases over the years and "closely, carefully, and painstakingly examines these cases for what they show about changing patterns in care for the elderly, parent-child relations, [and] the tensions between family and commodification." The book discusses how these issues have changed or not changed over the years.

While the principles have likely remained unchanged the strategies to carry out wishes has undoubtedly shifted in recent decades. For example, Hartog discusses how in many circumstances elderly parents convinced children to provide the caretaking they needed with promises (sometimes legally enforceable, sometimes not) that family assets would be passed to them so long as the care was satisfactory. He explains that the core inducement of providing such care was the understanding that a family farm, home, bank account, or other asset would be passed to the child in exchange for the child providing the help that the elder needed with tasks like cooking, cleaning, nursing, or even just companionship. Hartog also discusses how elder law attorneys have gotten involved over the years to help seniors, particularly when those previous promises are not fulfilled.

As the book review author noted, elder law is an area that is finally coming into its own. While our New York elder law attorneys have been working on these issues for years, we appreciate that that it is still difficult for many families to find professionals with specific experience in the wide range of issues related to planning for seniors. Fortunately, most law schools now have at least one elder law course. Hopefully awareness of these issues will continue to grow so that more families take the time to plan in ways that take full advantage of the current available legal tools.

See Our Related Blog Posts:

Nonprofit Innovators Try to Shift Senior Care Away From the Nursing Home

New York Long-Term Care Near the Most Expensive in the Country

Last Thursday a group of elder care advocates, seniors, and local politicians held an event to raise awareness of the possible closure of area senior centers. According to a report in Staten Island Live, the gathering was specifically called to ask Governor Cuomo to refrain from making changes to state Title XX funding. The proposed changes would essentially cut roughly $25 million from the budgets of senior centers citywide. Held on the steps of City Hall, state Senator Diane Savino led the event where more than 15,000 letters were unveiled written by seniors explaining how the cuts would affect their lives. Our New York elder law attorneys are aware of the ways that many local elders rely on various support services offered at these facilities.

The Title XX funding accounts for about a third of the total financial support provided to these centers. However, the funding is discretionary and some are proposing that it be moved over to support child welfare services. If the changes are made over a hundred senior centers will be forced to close. Lillian Barrios-Paoli, the Department for the Aging Commissioner repeatedly emphasized that the lives of thousands of seniors would be made qualitatively worse if these proposals were to advance. She explained that "this is an issue that shouldn't even be debated."

Others are questioning why such a proposal would even be brought forward in light of the changing demographics. As we have often reported, the elderly population is the quickest growing age group nationwide. The trends are no different in our area. Baby Boomers are now beginning to retire--a trend that will last for decades. The growing senior population means that New York elder care planning needs to be conducted now in anticipation of the needs of this population. Eliminating services to this group would seem to be a step in the wrong direction. Senator Savino commented on the pressing concerns already facing seniors by noting that "we have enough things to worry about. Take this off the table."

The director of public policy for the Council of Senior Centers and Services of New York City noted that these facilities have been relying on the Title XX funding for the past thirty five years. She said that eliminating the money would have serious effects on the already vulnerable elderly population. For example, right off the bat there would be two million fewer meals provided to the neediest seniors every year.

See Our Related Blog Posts:

New York Elder Center Opens for GLBT Seniors

New Chairperson of Assembly Committee on Aging Discusses New York Elder Care

The results of a new long-term care planning survey were announced this week that shed light on both the perceptions and planning of Americans. As reported in Financial Advisor, the data suggests that a growing number of residents are aware of the need to conduct long-term care planning, but a majority admit that they still fail to plan as properly as they should. Specifically, the study found that eight out of ten Americans believe that it is vital to prepare ahead of time for the assistance they might need as they age. Yet, nearly half those respondents claimed that in their own case they remain unsure how they will provide for their long-term care when they reach their golden years.

Long-term care costs are high and rising. New York elder care in particular has often been noted as one of the most expensive in the country. Many local residents seem to understand the high costs. Almost two-thirds of survey respondents in the Northwestern Mutual Life Insurance Company survey believe that long-term care costs will rise faster than their savings, and they expect costs to double in the next fourteen years. Yet, even though most community members acknowledge the cost issues, fewer than one out of three survey respondents were actually saving for their long-term care or had plans in place to ensure that they would have access to the resources they need to receive the care that they prefer. As one survey organizer summarized, "There is a clear disconnect between what Americans understand about long-term care needs and the steps they've taken to prepare."

With many local residents struggling to deal with their daily short-term issues, our New York elder law attorneys understand how long-term care planning can seem like a luxury more than a necessity. Yet, it remains unwise to treat these affairs as something that can be handled down the road. Preparing for these potential costs now often results in immense financial savings later. As the survey data reveals, this is particularly true for women. Women were 25% more likely than men to have acted as a caregiver for another. Women continue to live longer than men--five years longer on average according to the Center for Disease Control and Prevention. Unlike their male partners, there is less chance that they will have a spouse to care for them at home. Therefore woman have much to gain from ensuring that plans are in place so that they can maintain their lifestyle while retired. Yet only 24% of women are saving for their future needs as compared to 32% of men.

See Our Related Blog Posts:

New York Elder Law Estate Planning is Particularly Important for Women

Be Aware of Potential Pitfalls with Joint Bank Accounts

On Wednesday Congressman Ted Deutch published an editorial in Politico advocating on behalf of a stalled federal initiative known as the Community Living Assistance Services and Supports Act (CLASS). The measure was hailed as the first federal attempt to address the nation's long-term care crisis. All those in our area who have dealt with the complexities and expense of finding proper New York elder care are likely familiar with this crisis. CLASS was part of the high-profile Affordable Care Act that passed Congress, but CLASS was recently suspended by the President.

The Representative explained that CLASS was essentially a means by which middle class families could have a voluntary and affordable long-term care insurance option. An important part of the CLASS program that needed to be addressed was the idea of "adverse selection"--the notion that insurance would only be bought by those who already needed the care. Of course, the maximum benefit is derived only when individuals have this insurance plan in place ahead of time. The measure is currently stalled specifically because of concerns about adverse selection. Yet, many, including Representative Deutch, believe that federal officials have statutory power to implement anti-adverse-selection measures.

CLASS was pushed by those who understand the looming problem facing the long-term care system. Only five percent of Americans have long-term care insurance, even though seventy to seventy five percent of all Americans will need some form of long-term care. The gap is often replaced by federal programs, like Medicaid. The Congressman explained that the reliance on Medicaid is unsustainable at the federal level. This is in addition to the fact that qualifying for Medicaid often requires residents to spend themselves into poverty, especially when planning is absent. Fixing the problem before it gets worse was the motivation behind CLASS. The measure hopes to steer residents away from the most expensive institutionalized care to more balanced programs that encourage cost-effective and resident-focused community care. Besides the cost savings, these programs are almost always preferred by seniors, because they allow them to live at home, maximizing their freedom.

Our New York elder care attorneys have frequently advised local residents on the benefit of this insurance. Long-term care insurance is simply the best method of ensuring two things: that assets are protected from these costs and that at-home care will be available if needed. As our attorneys have analogized, it is both a sword and a shield that residents can use to protect themselves down the road.

See Our Related Blog Posts:

You May Be Able to Bargain for Long-Term Care

Family Trustees Must Be Aware of Their Duties and Requirements

An article yesterday at Forbes explored an issue that has been dubbed "the ticking time bomb of eldercare." It is well known that many families are forced to adapt their lifestyle once they start having children to make concessions for childcare. However, our New York elder law attorneys know that many families are also forced to make similarly tough decisions to account for eldercare when aging parents are in need of day-to-day assistance. Many local residents still fail to appreciate the demands placed upon adult children and other loved ones when a senior reaches the point where they cannot live on their own without help. The challenges are particularly harsh for local residents when no elder care planning has been conducted ahead of time to ensure that resources are available to provide the needed aid.

Yesterday's article explains how eldercare expectations are very much rooted in old cultural norms. Specifically, in many families it is assumed that daughters will take care of parents as they age. Decades ago this was more logical as women were far less likely to be in the workforce and were more often available in their homes to assist parents throughout the day. However, those old realities are less and less true. Many more women have careers just as demanding as men. It is no longer easier for many adult daughters fit the care of their elderly parents into their lifestyle. Yet, cultural expectations persist, often making daughters disproportionately more responsible than sons for ensuring the well-being of their elders.

This cultural pressure may affect some women more than others. In particular, women with family backgrounds rooted in certain cultures--including Russia, India, China, and others--often face immense pressure to provide eldercare. For some that means ending a career that has taken a lifetime to build. As the authors of one study on the topic noted, "Eldercare is a serious issue...because its obligations and attendant guilt derail woman who are just hitting the peak of their careers."

With the percentage of the senior population expected to increase radically in the coming years, many more families will be forced to make difficult choices about eldercare. There is no answer that is best for every family, as every situation is a bit different, demanding tailored solutions. However, our New York elder law attorneys have worked with enough families on these issues to know that far too often the financial pressures involved in eldercare limit the options available. Everyone should visit a professional in this area to ensure that steps are taken so that resources will be there to accommodate whatever eldercare decision the family agrees is best when the time comes.

See Our Related Blog Posts:

Long-Term Care Insurance is Key Medicaid Strategy to Protect Assets & Allow Home Care

Hire Your Children For Caretaking Duties

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.

See Our Related Blog Posts:

Primary Progressive Aphasia Remains Little-Known Form of Dementia

The Rising Incidence of Alzheimer's Disease

America is at the beginning of what many have deemed a "demographic crisis" with tens of millions of Baby Boomers nearing retirement. Older community members have many different needs than younger residents, and many areas remain unprepared to meet those needs. Our New York elder law attorneys have spent decades working with residents on an individual level to help them plan for their long-term financial and healthcare needs. However, besides individual residents creating their own elder care plans, many advocates understand that preparation also needs to be conducted at the societal level to account for the changing character of the community.

This week Big Think explained a new World Health Organization initiative to encourage "age-friendly" urban zones that better integrate seniors into community life. New York City was spurred by the call and recently launched an effort known as the Age-Friendly NYC Initiative. In fact, the first "Aging Improving District" opened this month in Harlem. These districts are intended to complement traditional Business Improvement Districts and tap into the community resources of aging citizens. Advocates explain that the goal is to change the current impression of seniors as an economic burden on government into one where seniors are considered an economic asset that can contribute to a more vibrant society.

The initiative's proponents explain that "the aging of America is a deep structural problem that requires big-picture thinking from social innovators." Proper integration of seniors into community life requires consideration about all aspects of life, from transportation to housing. For example, in Harlem's new Aging Improvement District, local businesses are changing shelving and signage, libraries are changing their hours, and other adaptations are being made all with an eye toward the needs of seniors. Much attention is also being given to a new housing option known as "MedCottage." These are modular homes for the elderly that can be hooked up to the home of a younger caregiver--often an adult child. It is hoped that new ways to care for seniors at home will reduce the strain on medical facilities.

It is encouraging that local New York elder care initiatives like Age-Friendly NYC have buy-in from area leaders like the Mayor's Office, New York City Council, and New York Academy of Medicine. Yet, as encouraging as these steps are, it is clear that local residents cannot rely on public efforts alone to account for their personal needs. All community members should take steps as early as possible to plan for their long-term financial and medical futures by visiting a New York elder law estate planning attorney.

See Our Related Blog Posts:

Having "The Talk" With Elderly Parents

Tips for Children Caring for Aging Parents

Caring for elderly parents is a challenge for many area families. Our New York elder law estate planning lawyers understand the complex mix of issues faced by seniors who need help with day-to-day activities but want to keep their independence. Adult children often struggle to strike the right balance between helping out and allowing a loved one to maintain their preferred lifestyle.

This morning Time's "Moneyland" blog shared tips for families navigating this time in life. The author is currently helping his mother deal with dementia. He notes that preparation is essential. The problems associated with aging do not come instantaneously; most seniors only gradually need help with certain activities. It is helpful to plan for future aid at the first signs of struggle. Proper preparation includes a variety of things like ensuring wills or trusts are drafted, learning about your parent's financial situation, obtaining lists of important password information, and similar tasks. Handling these estate planning issues while parents are still relatively healthy may save a lot of trouble down the road.

Families with multiple siblings must ensure that specific roles are defined and the workload is shared. It is not uncommon for one adult child to feel like they are doing all the work in caring for a parent. Harmony is most likely to reign when each individual contributes in a way that matches their strengths. One child may be good at doing routine chores around the house while another may be best at handling medical and legal issues. Fewer disputes arise when responsibilities are identified ahead of time.

The author explains that communication is perhaps the most important part of the process. Family dynamics are often turned on their head when siblings must band together to help their parents. This reversal of traditional family roles can be destructive if family members do not work together. Sharing concerns, frustrations, and worries keeps everyone on the same page and prevents the situation from festering.

Caring for aging parents is a challenge. However, resources are available to help with this process and ease some of the fear and uncertainty. A New York elder law attorney can explain relevant legal issues. Mental health professionals, such as geriatric care managers, can reveal long-term effects of certain heath conditions. The National Association of Professional Geriatric Care Managers website may be a helpful starting point for many of these issues. In addition, city, county, and state agencies exist to share information and provide resources to families. It is important not to go it alone.

See Our Related Blog Posts:

Long-Term Care Insurance is Key Medicaid Strategy to Protect Assets & Allow Home Care

Do Not Let Long-Term Care Destroy Your Retirement Planning

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" »

An unavoidable statistical reality is that area women may be much more affected by New York elder law and estate planning issues than men. Demographics and life patterns are at the heart of the explanation. Women have a longer life expectancy and more often marry older companions. This explains how of all Americans over 65 years of age, 42% of women but only 14% of men are widowed. On top of that, women still have lower average lifetime earnings.

Those characteristics have profound effects on the lives of many women in our area. As explained Thursday in a newly published Forbes article, women are much more likely than men to face compromised living situations following retirement. However, those who have taken time to conduct proper New York estate planning have a better chance at avoiding major decreases in living standards in their later years.

Many ways exist for a surviving spouse to maximize their financial protection, no matter what their future holds. In fact, the tools to plan for the future are frequently in flux.

For example, federal estate tax changes enacted late last year offer new opportunities and risks for spouses to ensure their assets are protected and preserved in as efficient a way possible. For one, starting this year there are new rules for the amount of unused estate tax exclusion a surviving spouse can add to their own. This "portability" option may double the amount of money that a spouse can pass on to heirs untaxed. However, the portability does not automatically occur. Without proper planning, some spouses may fail to take advantage.

Continue reading "New York Elder Law Estate Planning is Particularly Important for Women" »

Opening up a joint bank account is one of the first things that some area seniors and their loved ones consider when they begin seriously analyzing their need to conduct New York estate planning. Providing a child or other trusted relative access to one's finances is often the easiest way for a potential victim of elderly financial exploitation to provide an extra set of eyes on their finances. With many unscrupulous individuals willing to prey on vulnerable community members for their own financial advantage, some protection is better than none.

However, as was discussed in a March New York Times blog post, the joint bank account option is typically a dangerous and inadequate means of protecting a senior family members assets.

The joint bank account can create problems for both the senior and the co-signer. If for some reason the co-signer has financial problems, that individual's creditors may be able to go after the senior's account, regardless of the elder member's connection to those debts. These accounts also include a right of survivorship, which entitles the family member who joins in the account to retain the proceeds following the older family member's death. The potential for complicated family disagreements around that issue are clear and should be avoided.

Fortunately much more comprehensive, tailored, and effective means of protecting and preparing an estate are available. For example, a New York elder law attorney would be able to explain that a more logical solution may be for a family to create a durable power of attorney. This legal instrument often provides more balance to fill the needs of an aging senior--this option comes with both rights and responsibilities for the family members involved.

Continue reading "Be Aware of Potential Pitfalls with Joint Bank Accounts" »

By Michael Ettinger, Esq.

A power of attorney will assist you in the event of possible physical incapacitation.
This means someone else can handle your legal and financial affairs that might require your physical presence, such as a real estate closing or refinancing. Later in life, it is imperative that you have your own plan for disability because

You get to choose the people you want to make decisions for you, be it family or friends, and

Your own power of attorney legal document affords them many more options than a legal guardian would have under the law to protect assets. For example, they can move much more in assets more quickly which, in a "move it or lose it" environment is crucial. Nursing homes in New York cost an average of $10,000 a month so the sooner you act, the more of your assets you are able to keep.

A legal guardian has to get a Judge's permission to move or protect assets which can take many months, not only possibly costing tens of thousands in nursing home costs, but potentially the same amount in legal fees to prosecute the matter. Worse yet, after all the time, expense and effort, a Judge may not act in your best interest because sometimes the Judge has a different view of the matter politically or considers the State's interests ahead of those of your family. If you have a power of attorney in the event of disability, the people you have chosen will do what's best for you.

In New York, a Judge has the authority to cancel a power attorney and substitute someone else of the Judge's choosing as your legal guardian. By creating a trust, however, you can completely protect against this. If you have a trust set up, where you name a back-up trustee or trustees, this defeats a guardianship proceeding for the trust assets. The Judge has no authority over the trust, so you are guaranteed to get the persons you choose. If you are unable at present to decide upon specific persons to act as your "power of attorney," you may ask your elder law attorney to perform trustee duties.

Get the person(s) you choose to make difficult financial and legal decisions for you in the event of disability. This often makes the difference between keeping your home and life savings and losing them. A New York elder law attorney can assist in the proper drafting and execution of a power of attorney.

Medicaid Supervisor for Ettinger Law Firm, Elizabeth Schalk, has been reviewing Medicaid applications for over fifteen years. Having worked in this capacity for a nursing home and an elder law estate planning law firm, Schalk has gained valuable insight and experience from counseling New York State residents in various counties about receiving Medicaid assistance.

"The most frequent thing I see is when someone's mom or dad is sick and s/he knows it will be a short time before his/her parent will have to go into a nursing home. All of a sudden, money gets transferred out of the sick parent's resources. The thinking behind this is that that this will make his or her parent eligible for Medicaid to pay for nursing home costs. Nothing can be further from the truth. In fact, these kinds of "gifts" can cause a delay in Medicaid benefits."

When a person transfers assets and then receives or applies for Medicaid-covered nursing home services, the local New York Department of Social Services ''looks back'' at financial transactions made within 60 months or five years from the first date on which the person was subsequently institutionalized and applied for Medicaid coverage.

A person in a nursing home or receiving equivalent services in a hospital is made ineligible for Medicaid coverage for a period of time after a gift or transfer of resources by the person or his or her spouse.

The person is ineligible for a period equal to the value of the resource divided by the average cost of nursing facility services to a private patient in the community.

The penalty period is based on the total amount of transfers and/or gifts divided by the New York State Regional rate set for each county by the NYS Department of Health in January of each year. The length of the ineligibility period is calculated by dividing the total, cumulative, uncompensated value of the transferred assets by the average monthly cost to a private pay patient of nursing home care in the applicant's geographic area as of the date of the application for Medicaid.

In New York City the average cost for nursing facility services for 2011 is presumed to be $10,579.00 per month. In Dutchess, Orange, Putnam, Rockland and Westchester counties it is $10,105.00. In Albany and surrounding counties it is $8,323.00.

If gifts are made into a special needs trust, an applicant may be exempt from the five year look back period penalty. Or, if gifts are a normal gifting pattern such as the same gifts each year for Christmas and written verification can be provided prior to the look-back period, these kinds of gifts often cannot be counted as a transfer for Medicaid purposes.

Before gifting or transferring money out of an estate, and especially if a nursing home is imminent, consulting an experienced New York elder law attorney with an on-staff Medicaid supervisor may assist in avoiding unnecessary delays in receiving state assistance.

written by A.K. Lehmann, ABA Paralegal

The recession has caused a dramatic new development in child rearing. According to a 2009 Pew Research Center study, 2.9 million children were being raised primarily by their grandparents in 2008 - up 6% from 2007 and 16% from 2000. The census data attributes financial problems as the chief cause of the sharp rise in seniors now having to assume more "traditional" child-rearing duties.

These duties will cause a real strain on seniors' budgets. Child care costs, like more groceries, clothes shopping, health care and activities can add up quickly. Depending on the length of time a grandparent will now be asked to assist in raising his/her grandchild, these expenses over time could be substantial.
These seniors may find themselves needing to readjust their time and money to accommodate their new and perhaps unexpected responsibilities.

In cases where resources are limited and already designated for long term care or nursing home expenses, it may make sense to consult with a New York elder law attorney. Prioritizing needs and allocating assets often takes an experienced counselor who possesses a broad view of existing financial and legal planning options. For example, a Medicaid Asset Protection Trust may be advisable to protect the assets ahead of time, since there is a five year "look-back" on this type of planning.

Statistic for this blog post came from The Wall Street Journal, 9/10/10