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Long Term Care Planning

What is Long Term Care Planning?

Long Term Care Planning in Southeastern Massachusetts

First, the term Long Term Care is used generally to refer to care which lasts beyond any rehabilitation stage. Many times the long term care patient will require ongoing skilled nursing or the patient will be deemed “custodial” in that they are not improving. It is important to remember that the long term care facility has a duty to put a plan together designed to achieve improvement in the patient’s status, or at least to maintain the current status. The long term care plan must be in writing and overseen by the physician, among other requirements. Sometimes, long term care may be provided in the patient’s home or another residence in the community. In other cases, placement in a long term care facility may be necessary in order to keep the patient safe, considering factors such as medical needs, mental capacity, support systems and finances.

Cost of Long Term care

Considering the cost of long term care (which in our experience averages approximately $10,000 per month in 2012 to private pay in a nursing home), many people do not want to wait until they are in a crisis to address this issue. Long term care costs can be devastating to a person’s, or a couple’s, life savings. Long Term Care Planning considers many factors, including the size and nature of the estate, the cost of care, the health of the individual(s), and various life insurance strategies and government benefits that may be helpful in paying the bill when the time comes. If government benefits, such as Medicaid (MassHealth) may be achieved, one goal may be to then protect the home and assets from the Medicaid lien.

Long Term Care and Estate Planning

Through this process, it will be important for the clients to have in place good, basic estate planning documents, such as a Last Will and Testament, a Durable Power of Attorney, a Health Care Proxy, a Living Will and a HIPAA Release. In this way, should the clients become incapacitated and need care, the path will be smoother, less expensive and controlled by a person selected by the client. For instance, a good Durable Power of Attorney will allow the selected person to make legal and financial decisions, such as in a Medicaid application, without need for the court process known as Conservatorship. Similarly, if the client is mentally incapacitated, a Health Care Proxy will allow the person named (usually a spouse or child) to make medical decisions without going through court in a Guardianship proceeding. These foundational documents are generally the first step in good long term care planning.

Medicaid Qualification Rules

Additionally, an Elder Law Attorney will explain to you the Medicaid (a.k.a. MassHealth in Massachusetts) qualification rules and gifting penalties. For instance, the attorney will explain to you which assets are “non-countable” under the Medicaid rules and how much income or which types of assets are acceptable. In many cases, the Elder Law attorney may be able to put make recommendations and put a plan in place to protect the family home and assets and toward qualification under the nursing home MassHealth regulations. There is also a “Community MassHealth” program with significantly different qualification rules. Community MassHealth may be helpful in keeping a senior out of a facility and safe in their own home.

Long Term Care Insurance

For those people for whom MassHealth (Medicaid) qualification is not possible or not advisable, the Elder Law attorney may refer the client out to an insurance specialist to discuss solution to the problem of long term care. For instance, a client may purchase long term care insurance which will generally pay for long term care at a selected amount of money per day and for a specific amount of time. For example, the long term care insurance may pay $150 per day for 3 years. While the terms of policies vary greatly, the insurance may pay if care is needed at home, in an assisted living facility or for nursing home care. Generally speaking, the younger and healthier you are, the lower your premium will be. If certain minimum amounts of insurance are in place when the senior enters the nursing home, Medicaid will not be able to lien the senior’s home.

Linked Benefits Insurance

There are also other insurance products which are a blend of long term care insurance and life insurance, sometimes called “linked benefits.” After discussion with the Elder Law attorney about issues to consider, the client should speak with an insurance professional about such policies, as often the plan will include a death benefit in the event long term care is never needed. In this way, the policy is not a “use it or lose it” proposition. The Elder Law attorney may review several issues to think about in choosing long term care insurance or linked benefits, and then refer the client to long term care insurance professional.

The attorneys at Surprenant & Beneski, PC stay current on long term care issues through ongoing legal education both in and outside of Massachusetts. Their regular attendance at the multiple meetings of the Massachusetts chapter of the National Academy of Elder Law Attorneys, the Massachusetts Forum of Estate Planners, the Academy of Special Needs Planners and other long term care and estate planning legal education helps our long term care attorneys to stay as current as possible. Our attorneys also regularly speak on these topics in the community.

Long Term Care Facilities

For a list of long term care facilities, please see our “Elder Care Guide for Southeastern Massachusetts, Cape Cod and Surrounding Areas.” This helpful guide includes some things to consider in choosing a placement, a list of nursing homes and assisted livings in this area, contact information for each, whether the facility has a specific Alzheimer’s unit, or accepts “Group Adult Foster Care” as a payment source, and thoughts on Medicaid qualification. The guide can be downloaded or mailed to you for free by going to the “Resources” tab on our website. If you or a loved one are facing a nursing home or assisted living stay, or want to plan ahead to protect assets from the cost of long term care, come in any time for a consultation and a roadmap tailored to your particular situation, goals, family and assets.