Take Simple Steps Early to Protect Your Most Important Asset: The Family Home

On August 1, 2016, Ohio changed its Medicaid regulations regarding the treatment of the home. Federal and State Medicaid laws recognize that the family home is often times the largest asset of an individual, and Medicaid rules account for the reality that the family home is critical to the well-being of a spouse, a child, or other family members. Still, the changes in the law make protection of the house even more difficult and cumbersome. Now more than ever, early planning involving the relatively simple act of transferring the home into an irrevocable trust can ensure that the home will remain in the family for generations, regardless of the need for long-term care.

Medicaid defines the “Home” as any real property in which an individual has an ownership interest and is the individual’s principal place of residence. A “principal place of residence” is the home to which a person would intend to return if they were absent, like in the case of a stay in a rehab facility or a nursing home.

Generally, the family home that is considered the principal place of residence by an individual or a married couple is an excluded resource, regardless of value. However, the new rules state that the home is no longer considered to be the principal place of residence and will be countable if the individual does not intend to return home. However, the rule states that a “temporary” absence from the home does not affect the exclusion of the home as

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Caring for Caregivers

Many of my clients are caregivers. They are often caregiving for their children with disabilities or for their elderly parents. Others are more distant relatives who have taken it upon themselves to care for their loved one. Although their situations vary greatly, I see many recurring themes. I see strength, compassion, and selflessness on a grand scale. I see struggle, grief, and a unique optimism that finds joy in the little moments. I would like to touch on some of those struggles and offer some solutions and hope.

Society fails to recognize the great sacrifices made by caregivers across the country. Approximately 34.2 million people in the United States are caregivers for an adult age 50 or older, according to a 2015 AARP report. About half are caring for a parent. Some caregivers retired early, reduced their hours to part-time, or quit their jobs entirely to care for their loved one. Unpaid family caregivers contribute $470 billion worth of care to the US economy. What I personally find the most frustrating is that this sacrifice is assumed by society and often goes unthanked and unrecognized. Caregivers often feel a sense of duty to sacrifice their careers, their time, and often, their own health. This results in martyrdom of our most kind and deserving citizens. Not only should we as a society better appreciate and care for our caregivers, but we must support caregivers in caring for themselves.

There are a few different ways to get support as a caregiver.

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Can I Trust That Life or Death Decision?

For years, I have been helping people complete durable powers of attorney for healthcare, living wills, and do-not-resuscitate (DNR) orders. Collectively, these documents are called “advance directives.” They give directions about the care desired in advance of the need for that care. Advance directives allow you to select whether or not you want your healthcare providers to stop giving you “life-sustaining treatment” when you are in a “permanently unconscious state” or a “terminal condition.” Additionally, a living will and a DNR order allows you to tell healthcare providers and emergency medical service providers that you do not want to have CPR given to you in those cases when your heart has stopped beating (cardiac arrest).

Inevitably these questions come up during my discussions with people about their advanced directives: “What if my health care providers are making a mistake?” “How can someone stop a mistake from being made?” The answer is that there are checks and balances built into the laws that control how your advance directives operate. Let me explain.

First, I think it’s important to make sure you understand the meaning of some of the terms in your advance directives. A “permanently unconscious state” means, that to a reasonable degree of medical certainty, determined using reasonable medical standards, your doctor and one other doctor who has examined you, determine that you are irreversibly unaware of your environment and you have a total loss of cerebral functioning. In a permanently unconscious state you have no capacity for pain or

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Aid is Available for Veterans and their Surviving Spouses to Help Pay for Long-term Care

As recently as 2012, Gallup estimates that about 13% of adults, including 24% of men and 2% of women, have served in the United States Armed Forces.[i]   For their service to our country, veterans are entitled to a variety of benefits through the U.S. Department of Veterans Administration (VA).

The fact is that many of our veterans and their spouses are aging or have a disability. Often, they require assistance with meeting their everyday personal care needs. Paying for this care can be very expensive. Assisted living facilities in Northeast Ohio typically cost between $4,500 to $6,000 or more per month.[ii] For veterans and their survivors, there may be help available. An important, but often overlooked, VA benefit is Aid & Attendance.

Put simply, Aid & Attendance provides compensation for those who are eligible and require the aid and attendance of another person. The individual in need of care must need the aid of another person to perform the personal functions required in everyday living. These are known as Activities of Daily Living (ADLs). ADLs include, among other needs, bathing, feeding, dressing, and attending to the “wants of nature.” Aid & Attendance may be received in the home, an assisted living facility, or a nursing facility.

Compensation may also be available to those who do not need regular aid and attendance, but are housebound. To receive compensation under the housebound allowance, which provides a lesser benefit than Aid & Attendance, the veteran or survivor must be substantially confined

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I Guess You Could Say My Mother Was … Different

By Terry Fries-Maloy, MSW, LISW

The call came around midnight on a cold night in January 2006. I was only half awake when I answered the phone, having been startled out of a deep sleep. “Your mother just died…” said the voice at the other end of the phone. It was the night nurse at the facility where my mother had been living for the previous several years. “We helped her to the bathroom, got her settled back in bed…and then she just stopped breathing…” The news came as a quite a shock to me, but…to be honest…as a bit of a relief, as well.

As far as I can piece together from conversations I have had with those who knew her before I was born and from my experience in the years my mother tried to raise her children and the years beyond, my mother suffered from serious mental illness most of her life. Was it from a childhood emotional trauma? Or a head injury she sustained in her youth? Or a chemical imbalance?   No one really knew for certain, they just knew that my mother was…different.

My mother grew up in an age when mental illness often went undiagnosed and ignored. Few people sought treatment for mental illness. Even fewer understood that most mental illness often does respond to treatment. Even fewer had insurance coverage that would offset the cost of treatment…if treatment options even existed back then. Many people with mental illness were sent off

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When NOT to Trust a Trust

Many married couples have established revocable trusts for one reason or other, and have transferred their homes to their trusts. Unfortunately, this sound and logical planning is turned on its head if one of the spouses becomes so ill as to require Medicaid-funded long-term care.

A home is exempt from Medicaid consideration (an asset-sensitive or means-tested program) if it is owned by either or both spouses, and at least one of them lives there. What may be surprising is that a home owned by a couple’s revocable trust (or, more precisely, by one or both spouses as trustee of that trust) is not exempt. Because of that rule, the home must be transferred out of the trust to regain its exemption. Sometimes that is easy and sometimes it is not, depending upon how the trust agreement reads. So that can be the first challenge.

The second challenge involves to whom the home should be transferred. Should it be titled to the healthier spouse? Should it be titled the same way as it was before the trust was created? Medicaid has definite thoughts on this. The only transfer Medicaid recognizes as legitimate is a transfer to the spouse who is ill and needs assistance. Once that is accomplished, the home regains its exempt status, but also becomes subject to estate recovery after both spouses are deceased. This essentially preserves Medicaid’s claim to the value of the residence.

Once the home is out of the trust and titled to the ill spouse

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