Payne, Black & Pickelsimer, LLC

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South Carolina's source for Elder Law and Special Needs Planning

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Many people refer to firms who do what we do as an Elder Law Firm, and in many respects they are right. Much of what we do falls clearly under the above definition. In fact we do all the things listed in previous paragraph. However we consider our firm more and we hope you will too. We consider ourselves personal family lawyers. We realize that most people have goals for themselves and their families. We focus on achieving those goals. We are a goal oriented firm. Whether your goal is for a comfortable retirement, to assure high quality health care, passing assets to future generations, protecting what your parents worked their life to build, making sure your spouse or your children are cared for after you are gone, providing for a disabled child, making sure your business passes to and benefits the people you love, staying in your home as long as possible, building wealth or just keeping what you have; we want to be there to help you. We can’t tell you how to make money, that’s your job; but we can show you how to make sure the assets you worked so hard to earn go toward achieving your goals for you and your loved ones. Whether that means helping you defend your assets or retrieving assets wrongly taken by others. Because earning it is just the beginning!!!

WHAT IS LONG TERM CARE PLANNING?

Long Term Care Planning is the process of preparing for the medical and housing needs of a disabled individual who cannot function independently. To be successful, the long term care plan must address, the level of care required, where that care can best be provided, who should provide that care, and funding the cost of the care. Payne, Black & Pickelsimer, LLC is a premier law firm in long term care planning. Our attorneys are highly experienced in the intricacies of the various long term care benefits programs, as well as long term care insurance and the medical services available to persons in need of long term care. We cannot emphasize enough the need for advanced planning in this area, and we strongly discourage a go it alone plan. Minor mistakes can cost tens of thousands of dollars of lost benefits. We want to help you be prepared. If you are concerned about how you or a family member will be cared for or how it can be paid for Contact Us. We have answers to your questions.

What follows is an overview of the types of long term care typically provided to senior citizens and those with dementia or severe disability. It is by no means an exhaustive discussion of this complex area of law. If you are concerned about a need for long term care for yourself or a family member, and how you will pay for it, Payne, Black & Pickelsimer, LLC can help. We want to be your source for Long Term Care Planning.

UNDERSTANDING LONG TERM CARE

When we discuss “long term care” we are generally speaking of care for a person who is mentally or physically disabled to a degree that he or she cannot function, or perhaps live, without assistance from others and that condition is not likely to change in the near future.

The types of long term care are generally broken into the following groups:

Acute Care. If a person’s medical needs are such that they need to be provided in a hospital, the individual is in need of what is referred to as acute care. Acute care is extremely expensive. The cost typically ranges several hundred to tens of thousands of dollars a day. Fortunately acute care is generally paid for by health insurance for those under 65, and by Medicare and/or Medicare Supplemental Insurance, for those over age 65 or disabled. If there is no insurance or Medicare Supplement, Medicaid may be available depending on one’s age, assets, and level of disability. Also the Veterans Administration may provide assistance to some Veterans through the VA Hospital System.

Intermediate and Skilled Nursing Care. Intermediate and skilled nursing care is care provided in a traditional nursing home, and is thus referred to by most as nursing home care. The distinction between intermediate and skilled care, is complex, and generally unimportant to the nursing home resident and his family. The cost of nursing home care varies greatly around the nation. In South Carolina the cost typically ranges from a low of about $5,500 per month to a high of about $6,000 per month. However, in other parts of the country the cost can be much more. As discussed below, Medicare and private health insurance typically pay only a very small portion of the cost of nursing home care. Generally payment for this level of care comes from one of three sources; private pay, long term care insurance, and Medicaid. Further, some nursing home care is provided through the VA Hospital and Nursing Home system and the Veteran’s Pension (i.e. Aid and Attendance Benefit) can provide some funding for nursing home care outside the VA system. Medicare, Medicaid, Long Term Care Insurance and Veterans Benefits are discussed in more detail below.

Residential Care or Assisted Living. The level of care immediate below skilled or intermediate care is referred to as residential care or assisted living. This type of care provided in a Residential Care or Assisted Living facility. In general persons needing this level of care are persons who do not meet the criteria for skilled or intermediate services but who, need a great deal of supervision and assistance and cannot live alone. Common examples of persons needing this level of care are early stages Alzheimer’s or dementia patients, individuals who are at high risk of falling and being injured, individuals who need help getting out of bed, or minor assistance in bathing and dressing, individuals who are no longer capable of preparing or obtaining meals for themselves, and individuals who need assistance in medication management. In general, people who are physically or mentally incapable of living alone, and who cannot or do not wish to have someone live with them.

The primary difference between a nursing home and a residential care or assisted living facility is the reduction in skilled nursing services. Nursing homes are required to have a certain level of licensed nursing staff, based on the number of patients, and provide skilled nursing services to their residents on a daily basis. While most assisted living facilities do have one are more licensed nurses on staff, they are generally not required to do so. Typically any licensed nursing staff is utilized to provide emergency nursing services, drug management, and to assist with assessing resident medical needs.

The cost of Assisted Living is moderate when compared to nursing home care. While, these costs vary greatly from region to region, they generally run from a low of about $1,500.00 per month to a high of about $4,500.00 per month if advanced dementia care is need. These costs are for a moderate facility and can be much higher in more expensive areas of the country. The cost generally depends on combination of the patient's needs, the type of facility (i.e. basic to luxury), staffing ratios, the type of room or apartment the resident is in, and of course the region of the nation the facility is located in. Medicare will not pay for assisted living, and in most states, like South Carolina, neither will Medicaid. Some states do provide an Assisted Living benefit through a Medicaid waiver program, and some have separate state programs. An example of the latter is South Carolina’s OSS (Optional State Supplement) program. These programs are typically geared toward low income persons who need assisted living, and sometimes the facilities participating in those programs will not be luxury facilities. Finally Veterans Administration Benefits may be available to assist with this type of care. This is discussed in more detail in the Veteran’s Benefits section of this web site.

Home Care. Home care is really different from previously discussed types of care, because virtually any level of care (perhaps with the exception of acute care) can be provided in one’s home if you have the manpower and/or financial resources to do so. It is possible to obtain skilled nursing assistance through various Home Health Agencies for the client residing at home; if the client meets the certain physical criteria Medicare may even pay for a portion of the cost. Lesser levels of care can be provided by family members, home care businesses, or paid sitters. Also, as additional support for families seeking to keep a family member at home, most communities have Adult Day Care programs. Like day care for children, these are places that provide care for disabled adults, so that a family caregiver can work. The disable family member must go to the facility, and be picked up by a certain time each day; however, many facilities do provide pick up and drop off services. These facilities are frequently only available during week days.

The cost of in home care is all over the board. It really depends on how much care is need, the level of care, the ability of family members to provide support, and available resources to help a family keep their loved one at home. Home care can easily be the most expensive of all long term care. For example if all a person needs is an untrained sitter, but he needs a sitter 24 hours a day, a family could easily expend $7,500 per month, and that does not cover employer taxes. Consequently for home care, which is what everyone wants maximizing available resources is extremely important.

FUNDING SOURCES FOR LONG TERM CARE:
 
In this section we discuss how most families pay for long term care for a loved one. The complexity and high cost make the process daunting. We can help you understand your right and make sure the cost is as low as possible. Never assume anything. If you have questions get answers. We want to provide those answers.

Private Pay. Let’s face it. A lot of long term care is paid for the old fashion way, with a check book. While there is no true accounting of the total cost private long term care, it is significant and at some point unsustainable by the vast majority of American families.

Medicare & Medicare Supplemental Insurance. While Medicare and Medicare Supplemental insurance play an essential role in the health care system, their part in long term care is minimal. Typically Medicare covers 100% of the first 20 days of rehabilitation in a nursing home or rehabilitation facility following a hospital stay of 5 days or more. After the first 20 days, those with the proper type of Medicare Supplemental Insurance can qualify for an additional 80 days of full coverage. In order to qualify for rehabilitation services the patient must be capable of benefiting from the rehabilitation, and the rehabilitation will be terminated when the patient stops progressing and does not need the rehabilitation to maintain his current condition.

Medicare will also pay for home health services from a licensed home health provider, if the patient qualifies. Beyond that Medicare is largely restricted to Doctor, Hospital, and drug bills.

Long Term Care Insurance. Long Term Care insurance is really a subset of private pay. Long Term Care Insurance is sold by a number of insurance companies, and must be purchased well in advance of a need for long term care. Once you have an illness that is likely to result in long term care, obtaining a policy will be difficult, unless your employer has a group long term care policy. Coverage depends on the terms of the contract. Most policies pay a per day rate, for a set period of time, once the insured begins receiving long term care services. The rate depends on the type of services. Typically there are differing daily rates for home care, assisted living, and nursing home care. We can assist you in evaluating your policy or in if you do not have a policy what level of coverage you may need.

VA or Veterans Administration Benefits - The Veteran’s Administration runs a number of health care programs for Veterans and their spouse. These programs can be very complex and availability generally depends on a number of factors, including whether one is retired military, rank and disability. However, one program often overlooked is the Improved Disability Pension referred to as Aid and Attendance. This program is available to any veteran or widow of a veteran who was on active duty during a period of war. This includes WWII, the Korean Conflict, The Vietnam Conflict, Gulf War I and Gulf War II. This is a needs based program, and eligibility is determined through an analysis of assets, income, level of disability and medical expenses. Nonetheless, many veterans and widows of veterans who are in need of long term care can qualify for this benefit, and the amount can be significant. As of December 2008, a married veteran can receive up to $1949 per month, a single veteran can receive up to $1,644 per month and the widow of a veteran can receive up to $1056 per month. For a more detailed discussion of what Veterans Benefits will cover and eligibility criteria go to the Veteran’s Benefits section of this website?

Medicaid. When all other methods of payment are insufficient for payment of long term care costs, Medicaid is the payer of last resort. For individuals who qualify physically and financially, Medicaid can pay a significant portion of, and sometimes the entire cost, of a person’s long term care. Medicaid can generally be accessed to pay for nursing home care as well as home and community based services. Though the benefit for home care are significantly less than for institutional care. The biggest hole in the Medicaid system however is assisted living. In most states Medicaid will not cover the cost of an assisted living facility.

Medicaid is a complex needs based program. Payne, Black & Pickelsimer, LLC is very experienced in navigating this complicated reimbursement system, bringing to the table over 40 years of combined experience in this field. For a more detailed discussion of what Medicaid covers and eligibility criteria go to the Medicaid section of this web site.

The forgoing information is subject to change at any time, and other more complex rules may apply. Do not rely on this information as you may not fully understand. If you need help in this area seek the assistance of a competent, experienced Elder Law Attorney. This site is not intended as legal advice. 
 
 

WHAT IS ELDER LAW?
Among lawyers, there really is no clear definition for the term Elder Law. Why? Because it encompasses so many areas. Such as, estate planning, Medicaid eligibility, Medicare law, Social Security law, wills, trusts, probate, retirement planning, health care planning, disability, incapacity, dementia, Alzheimer’s; and the list goes on. Perhaps the best definition I have seen is “Elder Law is an area of law which applies a holistic approach to addressing the unique legal needs of senior citizens, including retirement benefits, estate planning, health care, and other issues.” 

Elder Law and Long Term Care Planning