Many different types of facilities fall under the heading of “long term care facilities.” Assisted living facilities and nursing homes are both types of long term care facilities, but the two are radically different and cater to different sets of people.

Assisted Living Facilities

Assisted living facilities are geared toward elderly residents who are generally healthy and able to take care of themselves, but who need some extra help with daily tasks like bathing, dressing, cooking, or remembering to take medications. An assisted living facility is a communal living place that often features planned group activities, transportation, meals, housekeeping, laundry, and private living spaces.

Nursing Homes

Nursing homes, on the other hand, are medical facilities that cater to patients who have significant medical needs and often can’t function independently. They offer a hospital-like setting, with trained nurses or nursing assistants at the facility at all times.  Unlike assisted living facilities, nursing homes offer actual medical care. Nursing home patients have significantly less privacy than do assisted living residents, and it’s not uncommon for a nursing home patient to share a room with another patient.

For more information about choosing and paying for a long term care facility for you or a loved one, you can talk to an experienced elder law attorney.

The Law Offices Of Cheryl David is a member of the American Academy of Estate Planning Attorneys.

The struggle to pay for nursing home care can put a family between a rock and a hard place. According to Met Life’s 2010 Survey of Long Term Care Costs, the average cost of a private room in a North Carolina nursing home is $204 per day – that’s almost $75,000 a year!

For a family that has saved diligently and invested wisely, paying for care out-of-pocket can quickly deplete resources and derail retirement planning and estate planning goals. On the other hand, in order to qualify for Medicaid, an applicant has to fall below certain income and asset requirements. Without careful planning, a similar depletion of assets can occur.

In order to get around Medicaid eligibility rules and keep assets in the family, many people try to give their excess assets to their children or grandchildren before applying for benefits. Due to Medicaid’s five-year “look back” rule, this can be a mistake with serious consequences. Here’s how it works:

When you apply for Medicaid benefits, the program “looks back” a period of five years.  If you made gifts during the five years prior to your application in an effort to reduce your net worth and qualify for Medicaid, then your eligibility for benefits will be delayed. The length of the delay is determined by the value of the assets transferred during the look back period.  North Carolina assesses a one-month delay for every $5,000 worth of assets transferred.

So, if you gifted $50,000 to your son two years before applying for Medicaid, and then you gifted an additional $10,000 to your granddaughter one year before submitting your application, your eligibility to have Medicaid pay for your nursing home care would be delayed by 12 months.

As you can see, Medicaid rules are very specific, and failure to follow them can lead to life-altering consequences for you and your family. The five-year look back rule does not mean that Medicaid planning is not possible. It does mean that your best bet is to plan ahead, and to get the help of an experienced estate planning attorney.

The Law Offices Of Cheryl David is a member of the American Academy of Estate Planning Attorneys.

One unanticipated expense that can drain your savings and put a strain on your family is the cost of long-term care. Not all of us will need nursing home care during our lifetimes, but as Americans live longer, the likelihood of a stay in an assisted living facility, or even the need for a home health aide or adult day care becomes more and more of a reality.

There are three main sources of payment for long-term care:

1. Out of Pocket
2. Long-Term Care Insurance
3. Medicaid

No matter the source, paying for long-term care without jeopardizing your family’s well-being – not to mention your loved ones’ inheritances – requires some careful advance planning.   A helpful first step is to calculate how much different types of care are likely to cost.

It’s also a good idea to discuss long-term care with your estate planning attorney.  We can help you work long-term care costs into your overall retirement and estate plans, and may have helpful suggestions for how to pay for long-term care while preserving your nest egg.

The Law Offices Of Cheryl David is a member of the American Academy of Estate Planning Attorneys.

Have you heard the term “negative inheritance”?  It sounds like what might happen if you die with too much debt, and your kids have to pay it off.  But, of course, you can’t pass on your debt in the same way that you pass on your assets. So, unless they’ve signed for a debt along with you, your debts won’t be  passed down to your children.

What is a Negative Inheritance?

If you can’t pass your debt on to your children, how can you leave them a negative inheritance? You can fail to plan for your own long-term care costs, and the other needs you’ll face as you age.   A negative inheritance is what happens when the total resources your children spend on caring for you during your final years outweighs any financial inheritance you pass on to them after your death.

What’s a typical “negative inheritance” situation? It’s when a parent has the absolute best of intentions, and may even have a high net worth – on paper.  Unfortunately, a lot of that net worth is tied up in the house, and the parent hasn’t bought long term care insurance or otherwise planned for needing help during their final years.

The responsibility for providing that help, or helping pay for long term care, falls to one or more of the children, who often have to dip into their retirement savings.  Assuming the role of caregiver may very well mean that an adult child has to cut back on their own time at work, causing a loss of income.  And then there’s the non-financial toll that can happen even in the most loving and supportive families – things like loss of sleep, increased stress, and strained family relationships.

Estate Planning Can Help You Avoid Leaving a Negative Inheritance

How do you avoid leaving your children a negative inheritance?  Through careful advance planning.  We invite you to meet with us to talk about putting an incapacity plan in place, exploring options for funding long-term care expenses, and coordinating your estate plan with your financial plan so that your children are not the victims of unintended consequences.  Schedule your time with us today – (336) 547-9999.

The Law Offices Of Cheryl David is a member of the American Academy of Estate Planning Attorneys.

Choosing a nursing home for a parent or another loved one is an incredibly important decision, and it’s likely to cause you more than a little stress. Try not to worry too much:   With a little diligence, and a lot of attention to your instincts, you’ll be able to make the right decision. Here are a few tips.

1.Give yourself as much time as possible.  Emergencies happen, and time isn’t always on your side, but the more time you have to investigate your options, the better. And, even if you only have a short time to make a decision, try to be as calm and observant as possible as you evaluate your options.

2.       Ask friends and acquaintances. Word of mouth can be an asset. Ask friends, acquaintances and, of course, family members if they’ve had any experience with local nursing homes. Don’t substitute their judgment for your own, but pay attention to their stories – if they’ve had problems, you may experience similar difficulties.

3.       Investigate several facilities. Choose a few different nursing homes to compare. 

4.       Ask to see the latest state survey. The nursing home is required to make this available for review. If a copy of the state survey is not forthcoming, consider it a bad sign.

5.       Visit each facility at different times. You’ll want to make several different visits to each nursing home – and at least one visit should be during a mealtime.  Nursing homes tend to be best-staffed in the morning, so just visiting at this time might give you an inaccurate picture of how well the facility is operated.  Visiting at lunch- or dinnertime is likely to give you a better picture of how things are really run.  You’ll want to pay attention to whether the residents are interacting as they eat, whether those who need assistance actually receive it, and whether everyone appears well-nourished.  Also, pay attention to the demeanor of the staff members: do they seem relaxed, well-organized and happy to be at work, or are they stressed and short in their interactions with residents?

6.       Pay attention to the residents. Observe the residents – do they seem relaxed and content?  Are they well-groomed? Do they interact with each other, and with you?  If residents seem withdrawn and unhappy, you’ll likely want to look for another facility.

Above all else, pay close attention to your gut.  If your instincts tell you that a particular facility is not the right place for your loved one, don’t hesitate to move on.  With patience and persistence, you’ll find the place that fills the bill.

The Law Offices Of Cheryl David is a member of the American Academy of Estate Planning Attorneys.

Here’s Forbes’ list of “12 Important Financial Steps to Take in 2011“.   These are great tips, but why wait until June, July, October, or November?  We can help you make these important steps as easy as possible as soon as possible.  Call us today for a free consultation to review any of these estate, retirement, or long-term care planning matters – (336) 547-9999.

The Law Offices Of Cheryl David is a member of the American Academy of Estate Planning Attorneys.

Medicaid and Medicare…they have similar names and they both pay for medical care, but they’re two completely different programs.  Here’s an overview:

Medicare

The Medicare program is administered by the federal government, and it’s available to most Americans age 65 or older. You don’t have to meet any income requirements in order to receive Medicare benefits.

Medicare offers somewhat limited coverage, under these three categories:

• Medicare Part A is hospital insurance.  It applies to the basic expenses associated with hospital stays, in addition to covering some of the costs associated with short-term nursing home or home health care needed after a patient is released from the hospital.
• Medicare Part B is medical insurance.  It covers basic doctor visits, some lab costs, and expenses related to certain outpatient procedures and services.
• Medicare Part D is prescription coverage.  It provides coverage of certain prescription drug expenses.

Medicare also carries with it deductibles, premiums, and copayments, depending on the exact coverage you receive.

Medicaid

Medicaid is a federally-established program, but it’s state-administered, so the rules governing Medicaid vary from state to state.  Unlike Medicare, Medicaid is only available to people who fall below a certain level of income and assets.

However, those who qualify for Medicaid get broader benefits than Medicare recipients, including more coverage of long-term care expenses, and more coverage for expenses like prescription drugs, diagnostic procedures, and preventive care.

If you’re 65 or older and you meet the Medicaid financial requirements, you can be eligible for both Medicare and Medicaid.  The advantage to this is that Medicaid can cover expenses left unpaid by Medicare, like premiums and deductibles.

Concerned that you won’t meet the Medicaid eligibility requirements?  You should talk to a qualified estate planning attorney.  You might be surprised at what you can accomplish with proper advance planning.  Our office has an Elder Law Attorney on staff to help you navigate the complex world of Medicaid and Medicare.  Call us today to set an appointment with Beverly Eckard – (336) 547-9999.

The Law Offices Of Cheryl David is a member of the American Academy of Estate Planning Attorneys.

We hope you’ll take a moment to check our our November Newsletter.  With big law changes coming up in 2011 with regard to estate taxes, now is the time to make sure you (and your plan) are ready! 

Read our November 2010 Newsletter here.

The Law Offices Of Cheryl David is a member of the American Academy of Estate Planning Attorneys.

If you’re considering hiring an in-home caregiver for an elderly relative, you’ll want to interview several candidates.  And, at a bare minimum, you’ll want to make sure that whomever you choose has the following qualifications:

1. Experience.  The caregiver you select should have experience in the specific role he or she is applying for, along with the references to prove it.  Don’t just ask for references, be sure to check them, too!
2. CPR Certification.  This is a must; Even if you’re only hiring a part-time companion for your elderly loved one, you’ll want to feel confident that the caregiver has the basic skills to handle a medical emergency.  It’s not enough just to take the applicant’s word for it – verify that he or she actually is certified.
3. A Driver’s License and Reliable Transportation. Reliability, plus a clean driving record, are essential for any caregiver who will be transporting your loved one.  And even if the caregiver won’t be providing regular transportation, you’ll need to be sure he or she can get to your loved one’s home and that the caregiver and your loved one will have a means of transportation in case an emergency comes up.

Selecting a caregiver for an elderly loved one is not unlike choosing a nanny or daycare provider for a small child.  It’s just as important, and takes the same degree of research and care.  After all, this person will be coming into your home (or the home of your loved one) and will become an important part of your family’s life.

The Law Offices Of Cheryl David is a member of the American Academy of Estate Planning Attorneys.

As your parents age, the tension between their desire for remaining independent at home and your desire to keep them safe becomes more and more apparent.  The risk of falling is ever-present, it becomes harder for mom and dad to drive safely, and eventually, even tasks like bathing and dressing can become difficult.  Despite these increasing hardships as parents age, the move to a nursing home can be heartbreaking, both for you and your parents.

One option for delaying the transition to a nursing home and for keeping your parents as independent as possible is to bring a home healthcare worker into your parents’ home.  There’s a range of options available, and, while full-time, live-in nurses are one choice, they’re not the only one.  Here are some other options:

• You can have someone come in either full- or part-time.  Some families find that having an aide come to the home overnight is all an elderly loved one needs.
• A companion can come in just to cook, clean, or spend time with a loved one, without providing any hands-on personal assistance.
• A home care aide can come to the home to help with personal care tasks such as bathing and dressing, plus assist with meal preparation and cleaning.
• Home care also extends to having medical professionals, such as a physical therapist or a registered nurse, provide in-home care.  This assistance can include help with post-operative recovery. It can also include helping other caregivers with medically-intensive tasks.

Of course, if you’re considering home healthcare as an option for extending your elderly parents’ time at home, it’s essential that you do your homework.  Make sure you thoroughly investigate the background and check the references of any candidate you consider hiring.

If you have aging parents, we recommend that you schedule time to meet with Beverly Eckard, our Elder Law Attorney.  Call us at (336) 547-9999 to set your appointment with Beverly!

The Law Offices Of Cheryl David is a member of the American Academy of Estate Planning Attorneys.