Elder Care Services

With more and more people joining the ranks of the Golden Coalition, issues regarding Elder Care Services are becoming more prominent.  Elder Care Services encompass counseling and representing senior citizens, disabled individuals, their families, and their advocates regarding healthcare and long-term planning, public benefits, surrogate decision making, legal capacity, and the disposition and administration of estates.  It also includes assistance and counseling regarding insurance, housing, employment, and retirement.  As a Florida Bar certified Elder Law Specialist, Donna Sobel strives to address the following concerns:  disability planning using powers of attorney, trusts, and representative payees; healthcare decision making using living wills and healthcare surrogate designations; housing options including in-home care, adult day care, assisted living facilities, nursing homes, hospice care, and continuing care retirement communites; paying for long-term care; Medicaid asset protection planning; long-term care insurance planning; bill paying and care management assistance; and trust administration.

Did You Know?
1.  The US population over age 65 is expected to increase from 12.4% in 2000 to 19.6% in 2030.
2.  The number of persons over age 65 is expected to grow from 35 million in 2000 to 71 million in 2030.
3.  The number of people over age 80 is expected to increase from 9.3 million in 2000 to 19.5 million in
     2030.
4.  In 2009, the average life expectancy is 78 years.
5.  The worldwide life expectancy should grow by an additional 10 years by 2050.
6.  The Wall Street Journal has reported that the cost of long-term nursing home care is rising at 4 times
      the rate of inflation.
7.  The average per day cost of a private room in a nursing home in Florida is approximately $165 per
     day, which equals $60,000 annually.

We Can Provide Help and Counseling When...
1.  You are worried about how to pay for the assisted living or nursing home bills for your spouse or
     parent.
2.  Your mother is forgetting your name and not eating well, and it is no longer safe for her to live
     alone.  You have thought about selling her home.
3.  Your loved one, who was severely disabled in an accident, is receiving a settlement that will stop all
     financial support he is receiving from the government.
4.  Your parents have asked you to help with making decisions, but they have no legal documents giving
     you any authority.
5.  You strongly suspect that your father's friend is stealing his money. 

How Can We Help You?
At some point in our lives, most of us will be faced with the illness of a spouse or aging parent.  Ensuring the best care for your loved one is critical.  Yet, the fear of how to pay for that care can be overwhelming, causing you to take no action at all.  You do not have to be alone when making these important decisions.  Like the hundreds of clients before you, we will help you understand all of your options for qualifying for Medicaid while protecting as many assets as possible.

How Do I Apply?
In most cases, Medicaid eligibility can be obtained retroactively for up to 3 months.  In fact, we often see avoidable mistaked made by applying too soon, even if you think you meet Medicaid eligibility already.  So please do not allow anyone to apply for Medicaid until you have sought competent advice from an attorney who specializes in Elder Law.  In most cases, advance planning must be done prior to submitting the Medicaid application.  Our firm can help you develop a comprehensive plan to meet Medicaid's spend-down requirements, while protecting assets.
2009 Asset and Income Eligibility Levels*
Recipient Spouse
Assets Maximum:
$2000
Assets Maximum:
$109,560
Minimum:  N/A Minimum:  N/A
Income Maximum:
$2,022/month
Income Maximum:
Unlimited
Minimum:  N/A **Minimum:
$1,750/month
* Effective January 1, 2009
*** For purposes of determining spousal diversion amount

Will Medicaid Take My House Or Car?
A car of any value will not be counted as an asset.  As for a home which was previously exempt under the old law, the new Medicaid laws count a homestead of greater than $500,000 in value as a countable asset, requiring spend-down, in most cases.

If My Spouse Needs Medicaid, What Assets Can I Protect?
Assets exempt from Medicaid include:  a prepaid burial plan and burial plot; personal effects and furnishings; irrevocable prepaid funeral plan of any value, and life insurance with cash value up to $2,500.  Countable assets for the at home spouse may equal $109,560, while the ill spouse may keep $2,000.  While most income of an ill person must be paid to the nursing home, an unlimited amount of income belonging to the well spouse may be kept.
 
Does a Person On Medicaid Receive Substandard Care?
No, it is illegal for nursing care facilities to discriminate on the basis of how a patient pays for his or her care.  Individuals qualified for Medicaid receive the same care as private pay residents.

What if I Need Care, But Have Too Much Income?
In Florida, if an ill person's monthly income exceeds $2,022, Medicaid eligibility will be denied without the use of an "Income Cap Trust."  This specialized trust holds the excess income and allows for the ill person to obtain the needed Medicaid benefits.

What If My Spouse Needs Care, But I Have Only a Small Amount of Income on Which to Live?
The law clearly allows for income to be diverted from the ill spouse to the at home spouse so that his or her standard of living will be maintained.  There are minimum and maximum income levels set which may be diverted back to the at home spouse.

Can I Give Away Assets?
Giving assets to your spouse is perfectly legal and no disqualifications or penalties apply with regard to Medicaid eligibility.  However, giving assets away to a non-spouse within a lookback period creats disqualification which may last for several months or years; this includes the $13,000 (as of 2009) per year allowed under the gift tax law.

Unlike the old Medicaid law which viewed gifts of smaller amounts of little consequence, the new Medicaid law enacted in Florida on November 1, 2007 harshly penalizes gifts of any amount of kind.  As a part of our comprehensive Medicaid spend-down plan, we will discuss the impact of any gifts you (or your spouse) have made within the lookback period to your children, your church, or your favorite charity.  We will tell you whether you are currently disqualified from receiving Medicaid; and if so, how to cure your disqualification, thereby opening the door to immediate Medicaid eligibility.

Can I Protect My Assets With a "Medicaid Friendly Annuity?"
The new Medicaid law assesses a lengthy disqualification period for "balloon annuities" heavily used prior to the new law.  Under the new law, annuities are allowed under limited circumstances and must name the State of Florida as the primary beneficiary in most cases.