Category Archives: Healthcare Senior Tips

Understanding Miller Trusts for Medication Qualification

If a senior has a gross income of over $2,349 per month they will be required to set up a Miller Trust before they can be eligible.

To qualify for Medicaid, a senior’s income and assets must fall below the established Medicaid guidelines. Often a senior has too much income to qualify yet cannot afford the cost of their assisted living or nursing-home care. For example, the current federal income limit for Medicaid eligibility is $2,349 per month, but costs for care can range from $4,000 to $10,000 per month.

What is a senior to do in this case? Idaho allows seniors to establish a qualified income trust, called a Miller Trust, where the excess income, over the income limit can be placed. When a Miller Trust is established, a senior is able to qualify for Medicaid even if their income exceeded the income limit, as long as the excess income is deposited into a Miller Trust Account and used toward the cost of their care.

After a Miller Trust document is created and an account set up at a banking institution, the excess income must be deposited into the Miller Trust Account each month, and then spent by the Trustee toward the senior’s care costs and other limited needs. The Trustee of the account cannot be the Medicaid applicant, since they are giving up their rights to those funds and entrusting the Trustee to manage the funds. A Miller Trust is not a way to protect funds from Medicaid, but rather a way to hold income in a protected manner so it can be used to pay for the senior’s care and allow the senior to qualify for Medicaid.

In conclusion, if a senior applies for Medicaid and has a gross income of over $2,349 per month, they will be required to set up a Miller Trust before Health and Welfare will approve them. In these cases, we advise calling our office or consulting with an elder law attorney prior to filing a Medicaid application to ensure that approval for Medicaid is not delayed.

Tom Packer is an Elder Law Attorney serving all of Southeast Idaho. As part of his law practice, Tom offers Life Care Planning to deal with the challenges created by long-term illness, disability and incapacity.

 If you have a question about a Senior’s legal, financial or healthcare needs, please call us.

July 2020

Medicare Advantage

Medicare Advantage Open Enrollment Period

Open enrollment periods can be confusing! Understand your options.

We recently finished the annual Medicare Open Enrollment period for 2020, which ended on December 7, 2019. We hope you were able to review your Prescription Drug Plans and make adjustments as needed.

We are now in the Medicare Advantage Open Enrollment Period! This period runs from January 1st to March 31st each year. During this period, individuals who already have a Medicare Advantage plan are able to:

  • Switch to a different Medicare Advantage Plan; or
  • Drop your Medicare Advantage Plan and return to traditional Medicare, then sign up for a stand-alone Medicare Part D prescription drug plan.

Why might you want to make a change? Some individuals may not be happy with their current Medicare Advantage plan and may be unhappy with the network doctors or pharmacies in their plan.

What if you’re satisfied with your current Medicare Advantage Plan? If so, you do not need to make any changes at this time. You will still have the option to make changes during next year’s open enrollment period if your coverage needs change.

One extra note regarding individuals who qualify for a Low-Income Subsidy (Medicare Part D Extra Help): Even though Medicare’s Annual Enrollment Period ended on December 7th, those receiving “Part D Extra Help” are able to change their Prescription Drug Plans once per quarter throughout the calendar year. We’ll talk more about the Low-Income Subsidy/Extra Help program in an upcoming Senior Tip.

If you would like to review your options, contact your local SHIBA office

(1-800-247-4422 – SHIBA Medicare Helpline), your insurance agent, or go online to www.medicare.gov to review your plan options with Medicare Plan Finder.

Tom Packer is an Elder Law Attorney serving all of Southeast Idaho. As part of his law practice, Tom offers Life Care Planning to deal with the challenges created by long-term illness, disability and incapacity. If you have a question about a Senior’s legal, financial or healthcare needs, please call us.

January 2020

Understanding the Annual Enrollment Period for Medicare

It’s that time of year! Understand your options and plan choices!

The annual Medicare Open Enrollment period is upon us! During open enrollment, individuals can make changes to their Medicare Part D prescription drug plans, and also change or enroll in Medicare Advantage plans.

This annual open enrollment period lasts from October 15th to December 7th and any changes you make will be reflected starting in January 2020. For example, if you decide to change your prescription drug plan during open enrollment, the new plan will be effective on January 1, 2020.

Why might you want to make a change to your prescription drug plan or Medicare Advantage plan? Some people choose to change plans if they have high prescription drug costs with prescriptions that are not covered under their current Part D plan’s formulary (the plan’s list of covered drugs). Some people also may change plans if they are paying a high monthly premium for their plan, but have few medications and may be able to enroll in a plan with a lower monthly premium. Still others may change a Medicare Advantage plan if they have been dissatisfied with their current plan.

What if you are satisfied with your current coverage? If you are already enrolled in a Medicare Part D prescription plan or a Medicare Advantage plan and you are satisfied with your coverage, you do not need to do anything during open enrollment. Your coverage will automatically enroll for the coming year. Just remember, many plans will make changes to their coverage each year, so it is still a good idea to review your plan information.

Sometimes plans will discontinue service in your area and you may receive a non-renewal notice from the plan. If this occurs, or if you simply want to review your options, contact your local SHIBA office (1-800-247-4422 – SHIBA Medicare Helpline), your insurance agent, or go online to www.medicare.gov to review your plan options and choose a different plan that meets your needs.

Tom Packer is an Elder Law Attorney serving all of Southeast Idaho. As part of his law practice, Tom offers Life Care Planning to deal with the challenges created by long-term illness, disability and incapacity. If you have a question about a Senior’s legal, financial or healthcare needs, please call us.

September 2019

Advanced Care Planning

Communicating your healthcare wishes will ensure that you get the care you want.

Most of us dislike thinking about the possibility of an accident or illness impacting us, especially if something is severe enough to impact our ability to communicate our wishes for medical care.

While it can be difficult to think about these scenarios, when events do occur, circumstances are made even more challenging if you have not discussed and documented your wishes and preferences ahead of time.

The term “Advanced Care Planning” is often used to describe the process of learning your options for healthcare intervention, discussing your desires and letting others know your decisions. Let’s first outline the types of decisions that you might need to make:

  • Emergency Care Decisions  If you did not have a pulse, would you want to have CPR (cardiopulmonary resuscitation); if you were having difficulty breathing, would you want a ventilator used (a machine that breathes for you); if you could not take food and water normally, would you want artificial nutrition and hydration (such as a feeding tube) given? Generally, these measures are implemented temporarily until you recover from your illness or injury.
  • End-of-Life Care Decisions  This relates to your desired level of medical care if you are unable to communicate and your doctor has determined that you are terminally ill and will not recover. In this situation, would you want aggressive interventions, such as a long-term ventilator or feeding tube to be used or would you want simply to receive comfort care?
  • Choosing a Healthcare Agent  You can choose someone you trust to make healthcare decisions on your behalf if you are unable to make those decisions for yourself.

After determining your preferences, you need to make your wishes known. There are typically two main components to an Advanced Directive–a Living Will and a Durable Power of Attorney for Healthcare.

Living Will – A Living Will goes into effect if you are unable to communicate your wishes and a physician has determined you will not recover. In the living will, you specify in writing what treatment you do and do not want, and under these conditions.

Durable Power of Attorney for Healthcare – A Durable Power of Attorney for Healthcare names someone to make medical decisions for you if you cannot communicate and are unable to make decisions for yourself.

Other Documents – If you or a loved one is in poor health and has a clear preference for no Emergency Care, such as not wanting CPR or a breathing tube under any circumstance, you may also want to consider completing a POST (Physician’s Order for Scope of Treatment) form with your physician. A POST allows you to obtain a doctor’s order for a DNR (Do Not Resuscitate) status, if you do not want to have CPR to restart your heart, or other interventions, to keep you alive.

We recommend that everyone complete a Living Will and Durable Power of Attorney for Healthcare while they are competent and capable of communicating their wishes clearly. Often when a crisis strikes, you may not be able to communicate your preferences and your physicians and family members are left with the decision-making burden. Completing these documents allows you to clearly communicate your wishes, and also provides a gift for your family members to alleviate their distress and know they are acting according to your wishes in difficult times.

We are here to help if you have questions, would like assistance with understanding more about this process or preparing these documents, or need additional information or referrals to resources in your community.

Tom Packer is an Elder Law Attorney serving all of Southeast Idaho. As part of his law practice, Tom offers Life Care Planning to deal with the challenges created by long-term illness, disability and incapacity. If you have a question about a Senior’s legal, financial or healthcare needs, please call us.

July 2019

Staying in Your Home – A Review of Assistance Options

Don’t confuse Home Health with Home Care

Even when an older adult’s health declines, surveys show that the majority of Seniors want to live at home for as long as possible. Living at home provides a sense of independence and familiarity that is often not found outside the home.

However, Seniors often wonder about what options exist for in-home care and the terminology can feel confusing and overwhelming. To provide clarification, in-home care generally is divided into two distinct categories: Home Health and Home Care. Many people use the terms interchangeably, but they are two different services provided.

Home Health – Home Health is clinical, medical care provided by skilled, medical professionals, including registered nurses, physical therapists, occupational therapists, and speech therapists. It is not designed to be long-term and is often prescribed by a doctor following a hospitalization or surgery to aid in rehabilitation. Home Health services, for homebound individuals, may be able to provide a non-clinical caregiver to assist with basic personal care and bathing, but the focus of the services is skilled, medical care.

  • Typical services may include wound care, physical therapy, occupational therapy, medication administration, and nursing services.
  • Home Health services are covered by Medicare when prescribed by a physician. Medicaid also pays for qualified individuals.

Home Care – Home Care is provided by caregivers, or care aides, who are trained to assist Seniors with activities of daily living (ADL’s) and/or companionship. Home care aides may be Certified Nurse Assistants (CNA’s) but do not require certification. This is “non-clinical” care provided to Seniors who may need assistance to remain in their home. These services can be on-going for as long as they are needed.

  • Typical services may include meal preparation, house cleaning, assistance with dressing, bathing and grooming, transportation, companionship, and medication reminders.
  • Home Care services are not covered by Medicare. Payment options include private pay (typically approximately $20-$25 per hour), Long-Term Care Insurance, Medicaid for qualified, low-income individuals, and the VA Aide and Attendance pension.

Typically, Home Health services alone are not sufficient support for Seniors wanting to remain in their home, if they also need assistance with activities of daily living. However, many Home Care agencies exist that provide excellent service options to support Seniors and their family members. Additional supports, including Meals on Wheels for homebound individuals, and medical-alert devices, may also be utilized. A combination of Home Health services, Home Care services, community resources and family support is often the key to Seniors successfully and safely remaining in their homes.

We are here to help if you have questions, would like assistance with healthcare coordination, or need additional information or referrals to resources in your community.

WE WOULD LIKE TO INVITE YOU TO AN UPCOMING EVENT ON June 13, 2019:

Matt Rust, who specializes in wealth preservation & Tom Packer, Elder Law Attorney are presenting an EDUCATIONAL WORKSHOP about the cost and realities of long-term care. Thursday, June 13 at 6:00 pm at Tailwind Wealth Strategies – 3 NW Main Street, Blackfoot The biggest threat to your retirement income is related to longevity. There are benefits and options you may not be aware of.

We know it’ll be worth your time! (Refreshments!)

Tom Packer is an Elder Law Attorney serving all of Southeast Idaho. As part of his law practice, Tom offers Life Care Planning to deal with the challenges created by long-term illness, disability and incapacity. If you have a question about a Senior’s legal, financial or healthcare needs, please call us.

May 2019

Testamentary Special Needs Trust

By setting up a Special Needs Trust for your spouse in your Will, you can improve their quality of life.

If your spouse is disabled and receiving Medicaid or if there is a concern that your spouse may become disabled and need to apply for Medicaid to help pay for care, you may want to set up a Testamentary Special Needs Trust (a Trust created in your Will) to supplement your spouse’s needs beyond what is paid for by Medicaid.

Assets transferred into a Testamentary Special Needs Trust do not trigger the Medicaid asset transfer penalty, nor are they counted for eligibility purposes.The Trust is used to supplement the needs of your spouse over and above his or her care, support and maintenance.

A Special Needs Trust provides for material goods, services and experiences that will make your spouse’s life as pleasant and comfortable as possible. For example, expenditures for travel, companionship, cultural experiences, recreational activities and sporting activities may be paid for out of the Trust. The Trustee may use the income and principal of the Trust to pay for medical or dental treatments for which there are no private or public funds available. Supplemental care (nursing care, for example) rehabilitative services or assistance programs that are not otherwise provided for, may also be considered by the Trustee. In addition, Trust funds may be used to pay for the difference in cost of a private room, rather than a shared room, in institutional settings. All these things can greatly enhance your spouse’s life.

If you pass away before your spouse, and you don’t have a Special Needs Trust, the assets in your estate will go directly to your spouse and he or she would lose eligibility for public assistance programs. Your spouse would have to spend down the assets they received to $2,000 and then reapply for Medicaid. In that case, there would be no funds available to provide for the additional needs of your spouse, as mentioned above.

Supplemental Needs Trusts are legal, appropriate and encouraged by state law and statutes. These Trusts are set up by caring family members to provide for the extra needs of a disabled spouse, beyond what is provided by public benefit programs.

Tom Packer is an Elder Law Attorney serving all of Southeast Idaho. As part of his law practice, Tom offers Life Care Planning to deal with the challenges created by long-term illness, disability and incapacity. If you have a question about a Senior’s legal, financial or healthcare needs, please call us.

February 2019

A Gift for You!

This Booklet helps you know how to be more prepared for the future.

Dear valued client,

We are sending you the attached Booklet entitled “A Senior’s Guide to a Well-Planned Future.” This booklet is designed to help you plan today for a better tomorrow, by putting legal documents in place and communicating your desires to your family. We hope that you find it interesting and informative. You may also view the Booklet or download it from our website listed below.

We believe that life is good, and that we can choose to make it even better.   Having the opportunity to ‘connect’ with you each month through our Senior Tips is enjoyable for us and we hope it has been helpful to you. Often, we receive comments back from you which makes our day! We hope you have a very Merry Christmas, and we look forward to a happy New Year!

Sincerely, Tom Packer, Sandy Packer and Becca Freeburne 

Click here to view & download the booklet

Tom Packer is an Elder Law Attorney serving all of Southeast Idaho. As part of his law practice, Tom offers Life Care Planning to deal with the challenges created by long-term illness, disability and incapacity. If you have a question about a Senior’s legal, financial or healthcare needs, please call us.

December 2018

Take Joy!

The following is a quote my mother gave me when I was a young adult. She recognized the obligation and necessity of finding our own joy, peace and happiness. I had a local artist do the artwork around the quote; I then gave it back to my mother for Christmas. I hope you enjoy it as much as we have.

As we celebrate this holiday season and contemplate the beginning of a new year, let us find joy and peace and help those around us to find it as well.

We wish you a joyful holiday season!

 Tom Packer is an Elder Law Attorney serving all of Southeast Idaho. As part of his law practice, Tom offers Life Care Planning to deal with the challenges created by long-term illness, disability and incapacity.  If you have a question about a Senior’s legal, financial or healthcare needs, please call us.

December 2017

Involuntary Discharge

Understanding Facilities Involuntary Transfers/Discharges

Facilities must meet certain conditions for involuntary discharge.

Do you have a loved one in a facility? Most of the time facilities provide compassionate, quality care to their residents. However, occasionally facilities will involuntarily discharge or transfer a resident against their wishes. A facility may only transfer or discharge the resident under the following conditions:

  1. It is necessary for the resident’s welfare and the resident’s needs cannot be met in the facility;
  2. The resident’s health has improved sufficiently so the resident no longer needs the services provided;
  3. The safety of individuals in the facility is endangered;
  4. The health of individuals in the facility would otherwise be endangered;
  5. The resident has failed, after reasonable and appropriate notice, to ensure payment for a stay at the facility.
  6. If the facility is going out of business.

Some examples of when it would be appropriate to transfer a resident are if the resident could transfer to lower level care, the resident is continuing to physically abuse another resident, a resident persists in smoking in the facility, or a private-pay resident promises to pay but doesn’t.

Examples of situations that would not meet the criteria for discharge are if the resident aimlessly wanders, the resident is making loud sounds, the resident’s refusal for treatment as long as it doesn’t endanger another resident, or conversion from a private pay rate to a payment at the Medicaid rate. If a resident is deemed to be “difficult” that is not reason enough for a facility to seek discharge.

If there has been a significant change in the resident but it is not an emergency, the facility must conduct an assessment to determine if a new care plan would allow the facility to meet the resident’s needs.

The resident’s record must document the facility’s efforts to resolve the situation before the decision to transfer is made. In addition, the facility must give a 30-day written notice to the resident of its intent to transfer, which includes a statement that the resident has the right to appeal the action to the State, and the facility must also include the name, address and phone number of the agency responsible for the advocacy of the resident.

Facilities exist to care for people with physical and cognitive problems. Problems present opportunities for finding solutions that allow facilities and residents to work together, and for facilities to do better for the communities they serve.

 

Tom Packer is an Elder Law Attorney serving all of Southeast Idaho. As part of his law practice, Tom offers Life Care Planning to deal with the challenges created by long-term illness, disability and incapacity.  If you have a question about a Senior’s legal, financial or healthcare needs, please call us.

August 2017

Good Communication

Best results come when we consult before deciding.

In the book Getting Together by Roger Fisher and Scott Brown of the Harvard Negotiation Project, they make the following recommendation: “If I have an ongoing relationship with you, I should consult you before making a decision that would significantly affect you.” They go on to say, “To consult means to ask your advice. It is not enough to tell you a decision after it has been made. Consultation does not require that we agree or that I give up such authority as I may have to make a decision. But it does require that I inform you of a matter on which I may decide, that I request your advice and views and listen to them, and that I take them into account in making a decision.”

The practice of consulting others before we make decisions that will affect them, opens the lines of communication, builds trust, improves relationships, and produces better outcomes—outcomes that are the result of the combined ideas, interests, insights and experiences of everyone involved.

I have noticed the tendency of some children to fail to consult with their parents as their parents grow older. They assume they know what’s best for the parent and begin making decisions in their parent’s lives involving the parent’s finances, healthcare, living arrangements—and even small decisions like what restaurant to go to or where to sit at a family gathering. This can be demeaning and even embarrassing to the parent who wants to maintain their independence and control over his or her life for as long as possible. Unless a person is incapacitated, a good rule of thumb to follow is to always consult before making a decision.

My wife and I have a saying that we try to follow when it comes to communication. It goes like this: “Speak freely, trust completely and forgive immediately.” First, we agree to speak freely—we should feel free to express our thoughts and positions without fear of being criticized or put down. Second, we agree to trust completely—we make a commitment to always give the other person the benefit of the doubt, to assume that they have our best interest at heart and that they desire to communicate without offending or alienating us. And third, we agree to forgive immediately—we have learned that no matter how hard we try or how long we practice, we fall back into old patterns and make mistakes, and therefore we agree to forgive immediately if offended.

Communicating well with others is not easy, but it is worth the effort. By getting everyone’s point of view, it is more likely we will have a better result. Taking the time to consult before deciding will have a positive effect on any relationship.

Tom Packer is an Elder Law Attorney serving all of Southeast Idaho. As part of his law practice, Tom offers Life Care Planning to deal with the challenges created by long-term illness, disability and incapacity.  If you have a question about a Senior’s legal, financial or healthcare needs, please call us.

July 2017