It is no secret that Connecticut’s nursing home “system” leaves a lot to be desired. We pay outrageous costs for average and below average care in many cases. A new federal report revealed an even more alarming trend. Connecticut nursing homes are distributing anti-psychotic drugs to residents that do not need them. And for the big picture perspective, Connecticut nursing homes are distributing these medications faster than every other state in the country except Louisiana.

Unfortunately this report highlights why many families choose to have an attorney involved in their nursing home advocacy. A family member in a nursing home is vulnerable and rarely in a position to protect their own rights.

Source: WTNH Report

One of the Veteran Administration’s best kept secrets, which is an excellent potential source of funds for long term care (either at home or in an assisted living facility) are veteran’s benefits for a non service connected disability. Most VA benefits and pensions are based on a disability which was incurred during a veteran’s wartime service. There is another benefit, however – a pension program – available for individuals who are disabled due to the issues of old age, such as Alzheimer’s, Parkinson’s, multiple sclerosis, and other physical disabilities. For those veterans and widows (ers) who are eligible, these benefits can be a blessing for the disabled individual who is not yet ready for a nursing home.

There is a specific portion of the pension program which is of particular importance. This program is “Aid and Attendance” (A and A) and is available to a veteran who is not only disabled, but has the additional requirement of needing the aid and attendance of another person in order to avoid the hazards of his or her daily environment (in other words, someone needs to help you to prepare meals, to bathe, to dress and otherwise take care of yourself).

Under this program, a veteran can receive a maximum of $1,801.00 per month in benefits and a widow or widower can receive up to $976.00 as a maximum benefit for A and A for the year 2007. The applicant must be determined to be “permanently and totally disabled”. The applicant does not need to be helpless he/she need only show that he/she is in need of aid and attendance on a regular basis. Someone who is housebound or is in an assisted living facility and over the age of 65 is presumed by the Veterans Administration to be in need of aid and attendance.

This particular program has limitations related to the income and assets that are held by the applicant. However, in computing the income of the applicant, certain items can be deducted. Specifically, unreimbursed medical expenses (UMEs) paid by an individual may be used to reduce the applicant’s income. Home attendants or aides are an allowable medical expense deduction, as long as that attendant is providing some medical or nursing services for the disabled person. The cost of an assisted living facility, and even part or all of the cost of an independent living facility, can also be an allowable medical deduction to reduce your gross income to a much lower net countable income that may qualify you for veterans’ benefits.

Simplified Example: Bill Robert is a 66 year old veteran and, due to his health needs, has caregivers coming to his home for several hours each day. His income is $1800/month and he is paying caregivers $3300/month. Rather than deplete his savings of $45,000, he applies for a service pension through the VA. The VA considers the $3500/month he is paying to his caregivers unreimbursed medical expenses and subtracts the amount from his income. In other words, when calculating his pension, the VA considers his income to be negative $1500. He applies for benefits and is eligible for $1500/month to help him with his bills!

To file a claim for this benefit, it is wise to seek the involvement of an experienced elder law attorney who is familiar with estate planning, disability, Medicaid and veterans’ benefits. An attorney skilled in elder law can provide a veteran and the veteran’s family with appropriate pre filing consultations to determine the appropriate steps that must be taken to be able to determine if it would be right to apply for this VA benefit.

What is the difference between a family that loses hundreds of thousands of dollars to nursing home costs and a family that preserves hundreds of thousands of dollars from nursing home costs? In many cases, the difference is time and the desire to obtain effective legal advice from an experienced Connecticut Medicaid Attorney.

Let me share the story of a client of mine. This client one day mentioned that her mother “Helen” resided in an assisted living facility. Helen was doing well with no chronic health issues, although naturally she was getting older and her risk for Alzheimer’s and other chronic health issues increased every year. Like many people, Helen preferred the majority of her life savings pass on to her family rather than be consumed or at risk for possible nursing home costs that exceed $90,000 per year in Connecticut.

After reviewing the situation with Helen and her family to gain a better understanding of her wishes and the financial realities of the situation, I put together a plan to accomplish Helen’s goals of keeping her life savings within the family without jeopardizing her own eligibility for Title 19 Medicaid benefits. Helen’s family promptly reviewed and acted on my recommendations. We did not give everything away and leave Helen at risk to her family’s desire to pay for expenses nor did we assume any risks without a thorough discussion of those risks and careful hedging against the unavoidable risks. Helen was my client and she was protected throughout the entire plan.

The reason I bring this up now is to remind everyone about time. My work with Helen began approximately three years ago. Back in 2004, I completed the initial analysis for Helen’s family which was the foundation for evaluating asset protection and Title 19 eligibility strategies. A critical portion of that analysis was making a reasonable, realistic, and informed estimate for how the next three to five years would unfold in terms of health and finances. I am proud to say Helen and her family have been exceedingly pleased with results. As we approach the third anniversary of Helen’s planning, her goals have been accomplished and the critical three year look-back window (this was before the DRA of 2005) is going to close in the very near future. The plan was carefully thought out and it was successful. I helped Helen and her family protect over $900,000.

Let’s consider an alternative for a moment. What if Helen’s daughter mentioned her mother’s situation to me back in 2004 and I told her that since everything was fine right now they should not consider any additional planning until it became obviously necessary? Well, as you may know the Deficit Reduction Act of 2005 was enacted which extended the look-back period to five years. This change alone would have had a significant impact on Helen’s ability to achieve her goals. There were additional restrictions on Title 19 eligibility included in the Deficit Reduction Act of 2005 that would have also had adverse effects on Helen’s options.

It is an unfortunate fact that Connecticut nursing homes are expensive. They average over $9,000 per month. It is also an unfortunate fact that none of us know who is going to need nursing home care and who will not need nursing home care. For many people, nursing home costs are the single greatest threat to their life savings and their estate plan. An annual bill of more than $90,000 can devastate a modest family.

What’s the difference between protecting over $900,000 and risking over $900,000? As we can see, in many cases it is a matter of time and getting the right legal help. I don’t know when the next wave of regulations or case law that further restrict Title 19 Medicaid eligibility in Connecticut will come along and in general I don’t recommend my clients wait to find out either. I do know what I can do today to secure my client’s estate plan and life savings. Medicaid planning and protection does not happen overnight. In Helen’s case, it took three years; and she is in a much better position than if she waited until the last minute.

Do you have a plan?

Are you protected? Do you want to be in charge of what happens to you, or are you content to hope for the best? Speak with a Connecticut Medicaid Attorney today and take the first step to protecting your family.