The Connecticut Elder Law Blog

Who's Eligibile for a Reverse Mortgage?

Many of my clients who are on fixed incomes and hurting in this down-economy often wonder if a reverse mortage is a viable option for helping them make ends meet.

Here are a few things to remember about eligibility for a reverse mortgage:

1.  You must be at least 62 years old.  If you're a married couple or co-owners then both of you need to be at least 62.

2.  You must own equity in the home.  An outstanding balance on the first mortgage is not a deal-breaker.

3.  The house must be your primary residence. 

If you need a referral for a good reverse mortgage specialist in the Hartford County area, please contact me off-line.

"Aging in Place" Has its Downsides Too...

I thought I'd pass along this thought-provoking article from Kaiser Health News. 

Whenever I'm called upon by the Probate Courts to act as a conservator for an elderly person my natural instinct is to always do whatever is necessary to allow the person to live at home for as long as possible. 

But Howard Gleckman's article reminds us that it ain't quite that simple.  Living at home is no cakewalk in most cases, particularly when it comes to addressing social issues. 

Health Care Reform Bill Encourages Home Care

It's a little challenging to digest all the moving parts of the current proposals for health care reform.  But one aspect of the Senate Finance Committee's proposal kinda jumped out at me: the "Community First Choice Option". 

This option provides partial federal Medicaid reimbursement to states that establish community support programs for people with disabilities.  Such programs would only apply to people who require an institutional level of care, caps on the number of people under the program would not be allowed, nor would waiting lists for services. 

Please note that the proposal does not make programs for home health care mandatory and it provides funding only for the next five years.  Nonetheless, this certainly falls under the "step in the right direction" category!

Click here for more detailed information on the proposal from the National Coincil on Independent Living (NCIL).

Medicare A,B,C's. And D's.

Many of my clients get confused between the Medicare and Medicaid programs, partially because the names of the programs are so similar.  Another source of confusion is the fact that nursing home care is mostly covered by Medicaid (if you qualify), but Medicare also covers the first few months of nursing home care (under certain conditions).  But I suppose confusion with government benefit programs is not unprecedented.

Please note that you don't need to worry about Medicare yet unless you're (a) age 65 or older, (b) under 65 with certain disabilities, or (c) any age with end-stage renal disease.

Anyways, here's a little primer on the Medicare alphabet.  Please remember that the extent and length of coverage varies greatly depending on the circumstances.

Medicare Part A ("hospital insurance"):  Covers inpatient care in hospitals.  Also covers some skilled nursing care, hospice and home health care.

Medicare Part B ("medical insurance"):  Covers doctors' care, outpatient care as well as some preventative care.

Medicare Part C ("Medicare Advantage Plans"):  A health coverage option run by private insurance companies (like HMO's and PPO's).  These companies have been approved by and under contract with Medicare.

Medicare Part D ("prescription drug coverage"):  Prescription drug coverage run by private companies, approved by and under contract with Medicare. 

That's as simple an explanation of the Medicare parts that you're going to find.  But of course, there are lots of details.  Please click here for the Medicare website, which is very comprehensive.

Medicaid Expansion in the Health Care Debate

While the national debate surrounding the overhaul of the health care system has increasingly focused on whether or not to offer a "public option", there are many other important issues that have not received nearly as much of the public's attention.  One of those issues which is particularly important to my clients is the proposed expansion of the Medicaid system.

The current House bill would add 11 million people to the Medicaid program, triggering a $438 billion price tag over ten years with the federal government covering all of it until 2015, at which point federal funding would drop to 90% and the states would have to pick up the remaining 10%.  For some reason I'm having trouble finding what the current Senate bill says about Medicaid.

In any case, click here for an interesting report from Kaiser Health News, and here for Missouri's perspective on this.  Arizona doesn't sound thrilled about the Medicaid expansion here.

Comparing Nursing Homes on the Web

Once the decision is made that a loved one needs a nursing home, the selection of which particular nursing home is vitally important.  As you can imagine, the quality of care at nursing homes runs a rather wide spectrum.

A good starting point is actually the Federal government's Medicare website which has a nursing home comparison page.  The federal data there provides extensive information on Medicaid and Medicare-certified skilled nursing facilities in your area.  They compare the quality of care for both rehab and long-term patients by including information on the percentage of patients whose walking has improved and patients with certain types of infections, such as bladder infections and bedsores. 

Please note that facilities with high percentages of bladder infections may indicate that they have trouble keeping their residents well-hydrated.  And unsually high percentages of bedsores hint at facilities not turning residents side-to-side in bed often enough and not keeping them clean.   

So, if you're looking for a nursing home for a loved one, or suspect you may need one in the foreseeable future then you may want to begin the search by taking a spin on the Medicare website.

Keepin' it (Relatively) Simple with "Small" Probate Estates in CT

As you take whatever steps that are necessary to avoid probate in Connecticut (which seems to be a passion for many of my clients) you should keep in mind that the probate process for "small" probate estates is pretty quick and straightforward.

"Small" is, of course, a relative term.  As far as the State legislature is concerned, your estate is small if your probate assets are under $40,000.  "Probate assets" are assets that are solely in the name of the decedent and do not have a designated beneficiary.  So, joint assets and things like life insurance policies, annuities, 401K's, IRA's, POD (payable-on-death accounts) etc. are not probate assets.

Please note that the threshold amount for "small" was $20,000, but that was increased to $40,000 in 2007.

Generally speaking, if it's a small estate you only need to file the following with your local probate court (although it may not be long before you won't have a "local" probate court): (1) an "affidavit in lieu of administration" or Form PC-212, (2) original death certificate, (3) the funeral bill and a receipt or outstanding balance amount, if any, and (4) a CT-706NT, which is an estate tax return listing everything that was in the decedent's name so that the Court can confirm that there is no tax.

If there is no will then the remaining funds will be distributed in accordance with the laws of intestacy, which is to say it goes to the next-of-kin under CT law.

If there is a will and the distribution instructions are not consistent with the laws of intestacy then you can still keep it simple if all the heirs waive their right to contest the will.  The Court will then simply order distribution pursuant to the will's instructions. 

Of course, if the heirs aren't interested in signing waivers for some reason then the will has to be submitted to probate.  At that point the simple, expedited process is out the window and you're looking at a full-blown probate process. 

If you have some time on your hands and you're not intimidated by judicial forms and some paper-pushing then you can probably tackle a "small" probate process on your own without legal help.  Otherwise, it probably makes financial sense to simply hire an experienced probate attorney who can wrap up the process quickly.

Huge Change to State's Prescription Drug Coverage!

The State currently pays for prescription drugs that your Medicare Drug Plan (Part D) does not cover.  Three days from now that will no longer be the case!

As of June 1st if you are prescribed a drug that you are (a) not currently taking, and (b) that drug is not on your Medicare Drug Plan's formulary then the State WILL NOT PAY FOR IT!  Yikes.

So if you have a drug that fits the above description then it's time to contact your provider and see if there are alternative Medicare D drugs that will help.  If not, the provider may ask Medicare D to grant an exception so that the drug will be covered by Part D.  

For more info, the phone number for the State's Pharmacy Unit is 860-424-4880 or 1-800-340-0715.

The Boston Marathon and "Good Pain"

I just returned home from running the Boston Marathon and I was pretty excited with my time of 2:55, which was my 2nd-fastest time out of 11 Boston Marathon campaigns. However, I now have the challenging physical aftermath to deal with.  My quads and achilles tendons (particularly my left achilles) are downright killing me and they won't be back to normal for several days.  Suffice it to say that my young-and-crazy days of being able to do a workout a couple days after finishing a marathon are long gone. 

During the subway ride back to my car after the race, I e-mailed one of my paralegals and joked that she may need to ask one of my elderly clients if I could borrow their walker for a few days!  Then I realized that although I'm a good bit younger than my physically disabled clients, I will be able to relate to them on a certain level while I recover from the race.  Yes, the obvious difference is that I should be back to normal within a week (although my achilles may take a bit longer).  But in the meantime I'm getting a temporary taste of what life is like for many of my clients.

Driving home from a trip on your own and then unpacking your things, taking a shower and fixing dinner for yourself is usually not a big deal.  But each of those steps take on a whole new meaning if they take place within a few hours of finishing a marathon.  It's impossible to be comfortable for more than 30 minutes during the car ride, leaning over and picking things up off the floor requires a serious effort, and every downward and upward step calls for careful calculation to avoid over-straining the muscles.  How can my clients live like this?!

So my message is that you should try to avoid being too impatient with any slow-moving seniors that you encounter.  You'd be moving pretty slow too if your body felt the way theirs does.  And if you don't believe me, just hop into the next local marathon!

Nursing Home Admission and Timing the Medicaid Spend-Down

In this post I would like to mention that there is a distinct advantage if your loved one applies for admission into a nursing home while still having significant assets in his name. 

Federal law dictates that once someone is a resident in a nursing home then the facility must provide the same level of care that it provides to all other residents regardless of whether the nursing home's bill is being paid privately or by Medicaid. 

In other words, everyone gets treated the same.  At least that's the story once you're in a nursing home, but it's a whole different story before you get in.

Here's one thing most people don't realize: a nursing home receives only about 60% of their private rate when the resident is on Medicaid. 

Why is this significant?  Because if a nursing home has two applicants for admission and one empty bed, and one applicant has private funds while the other applicant is on Medicaid then the nursing home will take the private-pay applicant over the Medicaid applicant ten times out of ten.

So...when you're planning for nursing home admission, Medicaid eligibilty and the spend-down make sure that you discuss this important issue with your elder law attorney and plan carefully.

I hope everyone enjoys the weekend!