A Cautionary Nursing Home Tale

Add comment January 26th, 2015 03:07pm Cynthia P. Kuster

An article on the front page of the New York Times today entitled “To Collect Debts, Seizing Control Over Patients” discussed a case where a nursing home applied for guardianship over one of its patients.  The patient had previously granted her husband a Power of Attorney, and he claimed that the nursing home was bringing the action as a strong-arm tactic to get paid.  His wife’s copayments had risen dramatically and he was disputing the calculation.  This is not the only case of this type; nursing homes do occasionally apply for guardianships for incapacitated patients.

The case was messy, and highlights two important points.  First, it is crucial for you to have a Power of Attorney in place.  Then if you become incapacitated, you have a trusted agent in place who will look after your interests.

But second, it also highlights the fact that nursing homes want and need to be paid in order to stay in business.  Nursing home care is expensive for the nursing home as well as for the patient.  If a patient stops paying the nursing home, the nursing home cannot kick the patient out, and they are in a real bind.  Applying for guardianship is time-consuming and expensive; no nursing home undertakes such an action lightly.

The guardianship application of the nursing home may or may not have been in the best interest of the patient, and appeared to be undertaken in large part so the nursing home could get paid.  The patient was protected, however, by the Power of Attorney she had in place.  Both points are important: first, you need to protect yourself with a Power of Attorney; and second, if you need nursing home care, be aware that the nursing home needs to be paid and understandably, will take action to make sure they are.

Elder Law strategies are designed to protect your assets, while enabling you to receive long-term care and also – through private funds or Medicaid –to make the required payments to a nursing home.  These are key aspects of the Elder Law practice of Lamson & Cutner.

Medicaid Recertification and Pooled Income Trusts

Add comment January 21st, 2015 12:55pm Tracy Connors

Generally, once a year every Medicaid Home Care or Community Medicaid recipient must recertify for their Medicaid services.  The purpose of recertification is to allow the Medicaid system to verify that the recipient is alive, and to determine that the recipient remains eligible for benefits.  This is why Medicaid requires proof of the recipient’s current resources, income, and payment of health insurance premiums.

When a Medicaid recipient is using a Pooled Income Trust to protect surplus income, proper documentation regarding the trust will be required in connection with recertification. Documentation should include copies of the Master Trust, the original Joinder Letter, the Approval Letter, and a Verification of Deposits from the Pooled income Trust entity showing that the Medicaid recipient has been depositing their surplus monthly income into the trust account.

Some Medicaid recipients or their family members are able to handle the recertification process on their own.  However, many find that they need professional assistance.  An Elder Law firm can prepare and file the recertification and relieve the stress on the Medicaid recipient and their family.

Don’t be “blindsided”

Add comment January 14th, 2015 09:56am Cynthia P. Kuster

The Wall Street Journal’s MarketWatch section recently ran an article about actor Rob Lowe being “blindsided” when his parents needed long-term care. Like most people, he did not realize how much time, effort, and money it takes to care for someone with chronic needs, until it happened to him. He stated in the article that having “the talk” with your parents is extremely important, even if you or your parents are initially reluctant.

One important way you can begin the process is to have your parents execute a Power of Attorney. You can explain to them that, should something happen, this document will enable you to take care of their financial obligations, and – most importantly – assist them with long-term care planning. They can sign the document and put it in a safe place until needed. Then, in case of an emergency, they and you are prepared. If, for example, your father does not have a Power of Attorney and he has a debilitating stroke, you would not be authorized to manage his financial affairs. You would need to go through an expensive and frustrating guardianship proceeding at the very time you need most to be focusing on his care.

Foreseeing the issues that are most likely to affect seniors and the disabled, and preparing their clients to be able to handle them, is the work of Elder Law attorneys every day. Lamson & Cutner has deep experience in this field, and our clients tell us often how valuable it is to them.

AgingCare.com posts article authored by David Cutner

Add comment January 6th, 2015 05:06pm Cynthia P. Kuster

L&C partner David Cutner recently wrote an article, “Top 5 Strategies to Protect Your Money from Medicaid,” that was published on www.AgingCare.com . The article is an excellent introduction to some of the ways that seniors can obtain costly long-term care and other health care services without first being required to “spend down” their resources and face financial ruin and an uncertain future. www.AgingCare.com is “a community of caregivers facing the challenge of caring for an elderly loved one. Their goal is to provide a comfortable meeting place for the free exchange of ideas with knowledgeable professionals, responsive experts, and people just like you.” This excellent website provides information on a wide variety of topics related to caring for the elderly.

There are numerous proven, legal, and cost-effective strategies to help seniors avoid financial ruin and still get the home care and/or nursing home care that they need. These strategies can be complex, however, so using the services of a high quality, service-oriented Elder Law firm gives you the best opportunity to obtain a good outcome for yourself and your family. The article can be viewed here: http://www.agingcare.com/Articles/strategies-to-protect-money-from-medicaid-175434.htm

New Year, New Numbers

Add comment December 30th, 2014 12:24pm Julia M. Greenberg

January 1st is right around the corner, and with the new year comes updated Medicaid Income and Resource standards and eligibility limits for 2015.

GIS 14 MA/029: 2015 Medicaid Only Income and Resource Levels and Spousal Impoverishment Standards was recently published. It advises us of the income and resource levels used in determining Medicaid eligibility starting January 1, 2015.

The GIS can be found here: http://www.health.ny.gov/health_care/medicaid/publications/gis/14ma029.htm

The following figures are some of the most relevant updates for those applying for Medicaid benefits and their spouses.


  • For a single person: $14,850
  • For a household of two: $21,750

Monthly Income for those residing in the community:

  • For a single person: $825 plus the $20 disregard = $845 per month
  • For a household of two: $1,209 plus the $20 disregard = $1,249 per month

Community Spouse Resource Allowance Maximum (CSRA): $119,220
The CSRA Minimum remains at $74,820

Minimum Monthly Maintenance Needs Allowance (MMMNA): $2,980.50

Personal Needs Allowance for certain waiver participants subject to spousal impoverishment budgeting: $384 per month

Home Equity Limit: $828,000

The full GIS can be found here: http://www.health.ny.gov/health_care/medicaid/publications/gis/14ma029.htm

We will keep you posted as additional figures are published.

We wish all of our readers a Happy and Healthy New Year!

David Cutner appears as guest on eCareDiary Radio Show

Add comment December 22nd, 2014 10:23am Cynthia P. Kuster

Founding Partner David Cutner was interviewed on December 16, 2014, on eCareDiary’s Radio Show. The “Q&A” focused on issues relating to planning and paying for long-term care. It was quite a lively discussion. If you missed the radio show when it was on the air, you can still listen to it by going to http://www.ecarediary.com/CommentRadioShow.aspx?id=248

At Lamson & Cutner, we believe that seniors should be aware of their rights and options regarding long-term care, which is so expensive. Families and caregivers need to be in the know as well. Listening to the radio show might be an easy way to get started.

David Cutner named as eCareDiary Expert

Add comment December 17th, 2014 10:55am Cynthia P. Kuster

We are pleased to announce that founding Partner David Cutner has been invited to serve as an expert for the “Expert Q&A” section of the eCareDiary website. eCareDiary describes itself as
“a web community created based on the founders’ experiences as caregivers for their parents … [it is] a centralized place to help families with care coordination, offering comprehensive online tools, expert content and resources.” Here is a link to the eCareDiary website: ecarediary.com.

“Expert Q&A” is an interactive online community within eCareDiary.com. It is intended to engage family caregivers to ask questions about any aspect of caregiving and eldercare, and to create a collaborative site for weighing options. The caregivers can respond to the experts’ answers with their own thoughts and insights. Numerous areas of expertise are included, such as Dementia, Care Providers, Cancer, Depression, Finances, Fall Prevention, Legal, Long Term Care, Successful Aging and End-of-Life issues.

Aging is a natural part of life, but it comes with complications. Having experts available to answer questions in a variety of fields can be extremely useful. Lamson & Cutner can answer your Elder Law questions on the eCareDiary web site, or by contacting us directly.


Add comment December 8th, 2014 12:29pm Kristina A. Slifkin

CaringBridge is an invaluable resource for families experiencing a major health challenge with a loved one (i.e. hospitalization, home with an illness). CaringBridge allows you to create a website (at no charge) to keep everyone in the loop with updates on health status, test results, visiting hours and other related news. You can gain access to relevant information regarding the loved one, share updates and offer words of encouragement. You can also use it as a vehicle to coordinate and schedule tasks such as meal delivery and arrangement of transportation. It’s a non-profit organization that serves more than 500,000 people each day. The organization is committed to using technology to amplify love, hope and compassion.

Please visit www.CaringBridge.org for more information.

Recalculating Your 2015 Pooled Income Trust Monthly Deposits

Add comment December 1st, 2014 11:10am Tracy Connors

Good news for approximately 64 million Americans who receive monthly Social Security and Supplemental Security Income (SSI) benefits: there will be an increase of 1.7% for 2015. For New York State Community Medicaid recipients, this also means they need to recalculate the monthly deposit to their pooled income trusts.

When New York State Community Medicaid recipients receive a Social Security Award letter, pension letter, or any other official information which indicates there has been an increase in their monthly benefits, they need to recalculate the monthly deposit to their pooled income trusts. The Medicaid system receives notification of the increases to Social Security benefits and applies them to each recipient’s budget.

To calculate the additional surplus that needs to be deposited to the pooled income trust, the Medicaid recipient should add the gross amounts of their monthly income such as Social Security, pensions and other forms of income, then deduct their monthly supplemental health insurance premium and Medicare Part B premium, and also subtract the 2015 Medicaid allowance. We suggest cushioning the net result with additional money in case there are any unexpected increases in income. The end result of these calculations will be the amount the recipient should deposit every month into the pooled income trust.

Social Security Increases for 2015

Add comment November 25th, 2014 10:26am Caitlyn McStay

The Social Security Administration has announced that Social Security benefits will increase by 1.7 percent in 2015, which translates to an average increase of $20.00 for the typical Social Security recipient. The 1.7 percent cost of living increase will become effective on January 1, 2015, but recipients should expect to receive a new Social Security award letter in the mail this December. For Medicaid recipients who are utilizing a pooled income trust, it is important to factor this adjustment into your income calculations for 2015. If you have questions about how this increase may affect you, contact an Elder Law attorney for more information.

Community Based Long Term Care: Home Care and Assisted Living Facilities

Add comment November 17th, 2014 03:26pm Julia M. Greenberg

A large percentage of senior citizens will reach a point where living alone is no longer safe and prudent. An elderly person who is living alone is exposed to many risks and dangers that could lead to injuries such as trips and falls. Living alone often compounds depression, anxiety and feelings of loneliness and social isolation. The senior may forget to take her medication, leave the stove on, or have difficulty bathing herself.

When such a change occurs, the senior and her loved ones must consider the best course of action.

The first option, for someone who is self-directed and wants to remain in her own home, is to hire a home care attendant. A home care attendant can provide assistance with activities of daily living, such as dressing, grooming, toileting, cooking and cleaning, in the comfort of the senior’s home. Seniors who feel isolated can attend adult day care centers and other senior programs in order to engage with others and remain socially active in their communities.

Another option is to move to an assisted living facility. Assisted living facilities are housing alternatives for seniors who choose to reside in a more supported environment. Assisted living facilities have amenities that provide for a broad range of senior’s needs in a holistic setting. The support of the staff and the companionship of fellow residents can greatly improve a senior’s quality of life and provide relief from loneliness and depression. If a senior requires additional assistance she can hire a private aide to care for her in the facility.

When paying privately, home care and assisted living facilities can be extremely expensive. Many people do not have long term care insurance to assist with the costs of care. If they have sources of income or financial assets, many mistakenly believe that they cannot access Medicaid benefits to help shoulder some of the costs. Because of these financial constraints and misunderstandings, people will not hire the help they need in fear that it will cost too much money, or alternatively, they will deplete their entire life’s savings paying privately for care.

It is crucial that seniors and their families know that Medicaid is available for those in need of long-term care who desire to remain in the community. Through New York State’s Managed Long Term Care program, Medicaid will pay for a home care attendant to provide care for those in need of assistance with activities of daily living.

Many assisted living facilities do not accept Medicaid payment for room and board. However, if the facility allows outside attendants, residents may be able to access Medicaid to pay for a home care attendant to provide additional care in the facility. There is also a Medicaid Assisted Living Program (“ALP”), which provides assistance, including room and board, to qualifying applicants at several assisted living facilities throughout the state.

Many individuals have been told erroneously that they cannot qualify for Medicaid because they have too many assets, too much income, or because they own their home, and that they must spend-down their assets before they can access Medicaid benefits.

After speaking to an Elder Law attorney you’ll realize that most people can qualify for Medicaid and preserve their life’s savings if they plan properly. They can also protect their income so that they may continue to pay their bills and support themselves in the community by using a pooled income trust. An Elder Law attorney can review alternative housing options, such as assisted living facilities, and analyze the potential costs, to help determine if such an arrangement is right for you. Do not make the mistake of assuming that you cannot qualify for benefits due to your current financial status before learning what options may be available to you.

2014 Alzheimer’s Association Report Shows Effect of Disease on Women

Add comment November 10th, 2014 10:00am Caitlyn McStay

The 2014 report from the Alzheimer’s Association showed that over 5 million Americans are affected by Alzheimer’s Disease. This number is expected to grow to 13 million over the next 35 years. According to the report, women are disproportionately affected by the disease. Three out of five Americans living with Alzheimer’s are women. Women over 65 have a one in six chance of developing the disease, compared to one out of eleven men. Women are also more likely to take on the primary responsibility of caring for loved ones with Alzheimer’s, with twice as many women as men acting as full-time care givers.

The cost of long-term care for individuals with Alzheimer’s is also on the rise, and according to the report, few individuals with Alzheimer’s Disease have sufficient long term care insurance or can afford to pay privately for long term care services. Fortunately, there are strategies available to assist with the care of those living with Alzheimer’s Disease. For information on these strategies, you can visit our website and download a free copy of our report, “The Top Ten Elder Law Strategies for Alzheimer’s Patients and their Families”, here.


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