You may have read the recent Buffalo News article addressing the cost of skilled nursing care in Western New York (How to keep nursing home costs from devouring your savings; Lou Michel, The Buffalo News, February 3, 2019). I am asking you to take a moment to think about the years of work and sacrifice and how long it took you to accumulate your assets. Now compare that to how quickly a lifetime of savings can be spent in a place where no one ever wants to have to live. It’s scary! Let’s face it, while saving for a rainy day sounds good (and of course, makes sense), the main reason that couples who have lived into their 80s have significant wealth is that they want to pass something on to their children.

Nearly everyone knows about skilled nursing and almost all of us are certain that it will be the neighbor’s dilemma. We just don’t want to think about it, so we keep delaying for one reason or another, hoping against hope that it won’t happen in our family. Don’t beat yourself up if you did not plan for this years ago. I’m pleased to be able to tell you that there are options available for nearly everyone who is faced with the prospect of having to pay for long- term, skilled nursing care – even at the eleventh hour (and fifty-ninth minute). In nearly every case, there are actions that can be taken to protect the assets you worked so long and hard to amass.

In Elder Law, we use the term crisis planning for situations where a family member suffers a catastrophic medical event and they have not done a single lick of planning. After a stay at the hospital, the discharge planner tells the family that rehab is the next step. After that, a long-term stay in skilled nursing will be most likely be necessary. And then … “Please fill out this financial statement so the nursing homes can review the applicant’s finances.”

Faced with the seemingly certain fate of losing both the homestead and the family fortune (which can range from ten or twenty thousand dollars to hundreds of thousands of dollars or more), families are frightened and have no idea what to do. I would suggest that you do not go with your instincts. Immediately consult with an experienced elder law attorney who has in-depth knowledge of the ins and outs of crisis planning. While crisis planning generally will not result in totally protecting your assets, in most cases a family can protect some, and oftentimes a good portion, of the assets that mom and dad worked so hard to accumulate.

What do you do?

The first thing you must do, under all circumstances, is to disclose all your assets on the financial statement in the Nursing Home application. There is no such thing as hiding an asset. Be thankful that in Western New York, at least, we have highly skilled, highly competent caseworkers who scrutinize every application to determine the total amount of resources owned by the couple and what, if any, assets were transferred in the last five years (60 months). They will find them, so it’s a lot less stressful to tell them up front what is there. At PBM, our staff conducts an audit of each applicant’s finances that meets, and, in many cases, exceeds the requirements established by the Department of Social Services. The more we know, the better we can serve you and the more assets we can protect.

The next thing to do is to meet with an elder law attorney and tell the attorney as much as you know about the finances. By the way, my experiences have shown the person in charge of the finances is often the one who needs the skilled nursing care. If you are the bill payer, make sure that your records are in order so that your spouse or a child does not lose critical, costly time searching for records because they are in the dark.

Even though you believe that all your assets are lost, this is almost never the case. Medicaid is a program of health insurance for people who are impoverished and cannot otherwise pay for needed medical care. The key to crisis planning is knowing what impoverished means in terms of Medicaid laws. It’s likely that you believe that in order to be impoverished you must spend down all your assets until there is nothing left for you or your spouse and you are ready for “the poorhouse.” However, that is not how our society defines “poor.” An attorney familiar with the Medicaid laws can guide you, direct you, and protect you, such that the nursing home resident may become eligible months (or even years) before the family thinks that assistance will be available.

At $350 to $500 a day, every delay is very costly. Even if you have made transfers in the last 60 months, there are steps that can be taken to mitigate some of the penalty and obtain Medicaid coverage for the applicant well in advance of the date that common sense tells you will be the result.

Don’t listen to tales of woe, rumors of families driven to abject poverty, and frightful tales of residents being evicted and left on the curb to fend for themselves. This is the United States and we have laws that are designed to protect society and the individual in all situations, including payment for medical care. Don’t guess at the law. Don’t believe you know the law. This a complex matrix of facts and legalities. Your best course of action is to employ an experienced, knowledgeable elder law attorney who can construct and complete a plan to provide coverage for your medical expenses at the earliest possible time while preserving assets that can be passed on to your children.

No matter what your circumstances, if you are faced with the prospect of long-term care and you did not do any advance planning, I urge you to seek help before surrendering to what seems to be inevitable. It’s never too late to plan!

If you have any questions about the above material or wish to speak to an attorney, please contact us at (716) 204-1055.

Crisis Planning, Long term care, Nursing Homes, Paying for Care, Perspectives on Aging