Nursing Home Planning or Long-Term Care Planning

An Elder Law attorney can help seniors and their families plan for, pay for, and obtain nursing home or home-based medical care for chronic illnesses, including planning for Medicaid eligibility to assist with paying for the nursing home (known in Missouri as vendor MO HealthNet).  Whether or not a person will ever end up in a nursing home, it is wise to plan for that possibility in order to be prepared in the event it does become necessary. Applying for Medicaid to assist in paying for the nursing home may also never be needed by most people, yet it should become the focus of your long-term care planning to ensure that no actions taken would ever preclude a person from qualifying for Medicaid if it did become a crucial part of the planning process at some point in the future.

Medicaid (MO HealthNet) has a 5-year look-back period, which means that any gifts or transfers of assets occurring in the 5 years prior to applying for Medicaid will affect a person’s eligibility. Every action a person makes within the 5 years prior to entering a nursing home should be taken with caution and with a focus on strategic planning. Proper planning for long-term care expenses, including the nursing home, can assist the elderly in protecting certain assets.

Understanding how Medicare, Medicaid, VA pensions, and insurance will interplay in each person’s situation will help in creating options and formulating an individualized plan. Many people don’t realize that Medicare is focused on medical assistance and will not pay for long-term nursing home care. Medicare was not designed to permanently fund a person’s stay in a skilled nursing facility. Because of this, people end up falling back on their retirement savings to pay for their care. Planning in advance can protect the bulk of that retirement savings when someone has a desire to leave those funds as an inheritance for their children. However, everyone has a different goal, so it is important to realize that planning is based entirely on what each individual person wants to accomplish.

Some people want to stay at home as long as possible, and their plan may include deliberately spending their own retirement funds to pay for care. Their goal may include setting up those funds to place another person in charge of paying the bills, such as with a simple trust. They also may wish to sell off assets in order to accomplish their goal.

Families often come together to formulate a plan which includes family members caring for elderly parents for as long as it is medically possible. These plans might include paying those family members for caregiver services or payment of rent if a parent moves into a child’s home. This is more complex planning than most families realize. Specially worded contracts prepared by an Elder Law attorney and doctor certifications must be used in order to avoid problems down the road if Medicaid becomes necessary. Making payments to family members without the proper paperwork will likely be treated as gifts which can create penalties or cause Medicaid disqualification in the future.

Other people are very passionate about shielding their assets to preserve them for their children or about not having children act as their caregivers. They may determine that Medicaid Asset Protection Trusts or gifts to children created 5 years in advance of entering a nursing home is their primary plan. There are also options for saving assets at the last minute when entering a nursing home without prior planning.

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