Glastonbury Health Care Center sued Carmine Esposito for breach of contract, negligence, promissory estoppel, and fraudulent misrepresentation to hold him responsible for over $100k in nursing home bills. Today we will review the claim for promissory estoppel.

A claim for Promissory Estoppel exists when “[a] promise which the promissor should reasonably expect to induce action or forbearance on the part of the promissee . . . and which does induce such action or forbearance is binding if justice can be avoided only by enforcement of the promise.” A critical element of promissory estoppel is the existence of a clear and definite promise which a promissor could reasonably have expected to induce reliance.

In this case, the court found that Carmine Esposito wanted Josephine’s care at Glastonbury Health Care Center to be paid for by Connecticut Medicaid. Carmine knew that a requirement of Connecticut Medicaid was that the assets of Josephine do not exceed $1,600.00. He knew that Glastonbury Health Care Center would not accept Josephine without her being approved for Medicaid. Carmine agreed to apply for Josephine’s Medicaid. He consented by his silence to accept the obligation of a responsible party (as defined in the admissions contract) to obtain and maintain Josephine’s eligibility for Medicaid. The Court concluded Carmine reasonably expected that Glastonbury Health Care Center would rely upon that conduct and promise to accept Josephine as a resident. Glastonbury Health Care Center did rely on Carmine’s conduct and promise. Carmine Esposito failed to obtain approval of Josephine’s application from April 1, 1998 to September 2000. As a consequence, Glastonbury Health Care Center lost Connecticut Medicaid payments for that period. Those facts establish the claim for promissory estoppel.

In response to the nursing home’s claim, Carmine responded that Glastonbury Health Care Center failed to exercise due diligence to sustain the truth as to Josephine’s eligibility for Medicaid. Relying on a 1982 case, the Court concludes that Glastonbury Health Care Center did not have a duty to exercise due diligence to determine that Carmine had made false promises.

In a second attempt to defeat the nursing home’s claim of estoppel, Carmine claimed that his silence during the nursing home admission process could not create the basis for the nursing home’s estoppel claim unless he had a duty to speak. The court concluded that since Carmine was seeking to have Josephine accepted by the nursing home as a Medicaid beneficiary, knew the nursing home would not accept Josephine without her Medicaid application being approved, and was apprised of his obligation to obtain and maintain her eligibility as a condition for her acceptance, he had the duty to object to that obligation. The court found that this duty to speak and Carmine’s failure to do so form the basis for estoppel.

This is the third example of Carmine Esposito’s big mistakes in applying for his mother’s Connecticut Medicaid benefits. His mistakes cost him over $100,000 of his own funds. A Connecticut Medicaid Attorney could have saved Carmine from this mess for a lot less than what the Court ordered him to pay the nursing home. A Connecticut Medicaid Attorney can help your family avoid Medicaid mistakes and being held personally responsible for nursing home bills.

Related posts:

1. How To Get Sued By a Nursing Home: Negligence
2. Nursing Home Wins $102,574 From Resident’s Son
3. Is Your Delay Causing a Breach of Contract?

In addition to the breach of nursing home admissions contract claims, Glastonbury Health Care Center claimed Carmine Esposito was negligent in getting Josephine’s application for Connecticut Medicaid approved. In order for the Court to find Carmine negligent, it has to find Carmine owed a duty to Glastonbury Health Care Center to exercise reasonable care. If Carmine owed the nursing home a duty, then it must also find Carmine’s breach of that duty caused actual injury to Glastonbury Health Care Center.

The Court found Carmine Esposito owed Glastonbury Health Care Center a duty to exercise reasonable care for many of the same reasons they found him bound to the terms of an admissions contract he never signed. Specifically, the court found:

1. Carmine prepared the application for Connecticut Medicaid benefits;
2. Lucy Higgins, from Glastonbury Health Care Center, informed Carmine of his obligation to provide all information requested by DSS and to “promptly and expeditiously establish and maintain eligibility for Medicaid assistance”;
3. Carmine knew Glastonbury Health Care Center would not admit his mother unless he accepted the obligation described in #3;
4. Carmine was silent and the Court found his silence indicated consent to these obligations.

The Court found Carmine owed a duty to the Glastonbury Health Care Center to obtain Connecticut Medicaid benefits for his mother, did he breach his duty?

The Court determined that he did fail to exercise reasonable care for the following reasons:

1. Carmine failed to liquidate a bond Josephine owned in a reasonable amount of time;
2. Carmine neglected to properly apply the funds of a bank account Josephine owned within a reasonable time;
3. Carmine and his attorney failed to respond to DSS requests for information on the bond and bank account.

Carmine tried to go through the Connecticut Medicaid application and eligibility process alone and he messed up. His mistakes cost him over $100,000 that the Court determined he owed to Glastonbury Health Care Center. Carmine might have been able to save himself the $100,000 (and the litigation fees) if he had chosen to work with an experienced Connecticut Medicaid Attorney.

Related posts:

1. How To Get Sued By a Nursing Home: Estoppel
2. Nursing Home Wins $102,574 From Resident’s Son
3. Is Your Delay Causing a Breach of Contract?

Effective 1/1/09:

The maximum MMNA a community spouse will be allowed to keep is $2,739. This is up from $2,610 for 2008-2009.

The minimum CSPA or “community spouse protected amount” will be $21,912. This is up slightly from $20,880 in 2008-2009.

The maximum CSPA (or assets the community spouse is allowed to keep without a hearing) will be $109,560. This is up from $104,400 in 2008-2009.

Does this mean you will not be able to protect more than $21,912 or $109,560 in assets from Connecticut nursing home costs? Absolutely not. An experienced Connecticut Medicaid attorney can help you protect everything you are entitled to, which in many cases is more than these basic rules provide.

Related posts:

1. Connecticut Medicaid (Title 19): CSPA
2. Connecticut Medicaid (Title 19): MMNA
3. Medicaid Spousal Refusal Update

In its most recent survey, the State of Connecticut determined the average monthly cost of a Connecticut nursing home is $9,464.00. This adds up quickly as some people put off implementing life savings protection for months or even years, and others put it off until it is just too late. There is a much less expensive alternative, but before we get to that we have to take a look at what many families are experiencing out there.

Connecticut nursing home costs are among the highest in the nation. Every day I see families stuck writing checks to nursing homes in amounts of $10,000 or more – with no end in sight. These families failed to plan ahead, and they are paying a costly price now. In many cases, these families lose all or a significant portion of their life savings to Connecticut nursing home costs. I wish there was more we could do, but when it is too late it is just too late.

Some families I see try to create their own life savings protection plan. I’ve never seen it work out the way they intend or think it will when people act without an experienced attorney. I see people all the time that have transferred their parent’s money to family members or themselves and for some reason many of these individuals think these transfers will not be a problem when they go through the 5 year look-back period while applying for Connecticut Medicaid nursing home benefits.

Every single financial transaction during the 5 year look-back period is subject to audit and assessment of a penalty if the State deems it a penalizing transfer. You may have the greatest rationale in your own mind , but if you have no evidence and no support in the regulations or case law you really have nothing except a big mess that will cost more to clean up than if you got professional help in the first place.

If what I described above sounds acceptable to you, then you may want to run down to casino and bet everything on black because you are quite the gambler. If you are not the gambling type, and want a strategy you can count on to protect your life savings, keep reading.

The other families I see are looking for solid protection for their hard earned life savings. I am proud to say that I help these families on a regular basis achieve their goals of protecting assets not only for children, but also for their spouse and themselves. It can be done.

You have options to protect your family against a Medicaid required “spend-down”. These options expire, and when they are gone they are gone for good. When you are within five years of needing Connecticut Medicaid nursing home benefits you will not be able to take advantage of these proven techniques. Nobody knows when their 5 year window will start, so most people choose to act sooner rather than later.

One popular option is The Connecticut Medicaid Asset Protection Trust which helps families protect amounts from $50,000 – $1,000,000.00. There are many other techniques that may or may not available depending on your unique situation. Together we can find a solution that works for your unique circumstance.

Doing nothing in July of 2008 just cost you $9,464 in lost asset protection. August is coming to add on another $9,464. See a trend here? The clock is ticking.

Related posts:

1. Estate Planning For Title 19
2. Title 19 Medicaid Protection Workshop
3. The Connecticut Medicaid Asset Protection Trust

In too many cases, families have transferred funds, made purchases, or otherwise acted on the annecdotal advice of people. I guess people start out with the assumption that obtaining Connecticut Medicaid nursing home benefits is really no big deal.

In most cases, applying for Connecticut Medicaid nursing home benefits is a very big deal. At the bare minimum, the process is an audit of the last 3+ years of financial activity for the applicant and the applicant’s spouse. The more assets and transactions a person has within that look-back period, the more complicated the eligibility process is going to be. And contrary to what many people think, nobody is entitled to receive Connecticut Medicaid nursing home benefits. It is the responsibility of the applicant to prove to the Department of Social Services that you qualify for benefits.

The Real Cost

Mistakes and delays during an application for Connecticut Medicaid nursing home benefits are costly. The nursing home bill and other medical expenses continue to pile up every month even when the Connecticut Medicaid application is pending. You may not see the bill until after your application is denied, but it is still there. A Connecticut Medicaid attorney can help get you through the process promptly while protecting your assets.

Related posts:

1. Critical Medicaid Mistake #1
2. Critical Medicaid Mistake #2
3. Connecticut Medicaid in Court – The Spousal Assessment

A lot of people are denied for Connecticut Medicaid benefits after their initial application. The reason why their application is denied could be any number of reasons. In some cases the application is incomplete or inaccurate. In some cases assets may be attributed to the applicant when they should not be. In some cases you may be entitled to Connecticut Medicaid benefits but the way the system is set up, it is just not within the power of the case worker to approve your application. This last case is very common with married couples.

Whatever the reason, if you have been denied Medicaid benefits the clock starts ticking. You can accept the decision and spend down your assets, perhaps more than you need to; or you can appeal the decision and request a hearing.

If you plan to appeal, you only have a limited amount of time. At the appeal stage you are facing a hearing with an administrative law judge that will base their decision to approve or deny your application on their interpretation of the relevant laws and administrative regulations. A Connecticut Medicaid Attorney can represent you and help present your case at this hearing.

Related posts:

1. Critical Connecticut Medicaid Mistake #3
2. Connecticut Medicaid in Court – The Spousal Assessment
3. Critical Medicaid Mistake #1

Connecticut had only two facilities on the most recent Special Focus Facility report. Chelsea Place Care Center is included in the list of nursing homes that have shown improvement while being a Special Focus Facility for 11 months. The Wethersfield Health Care Center is also identified as showing improvement while being in the SFF program for 37 months. Hopefully Wethersfield Health Care Center will graduate from the program soon after such a prolonged stay.

Additional information on what the Special Focus Facility program is and what it means to you as a consumer can be found here.

Related posts:

1. Veteran Benefits for Assisted Living and Nursing Home Care
2. 9 Questions You Must Ask If You or a Loved One is Going Into a Nursing Home
3. How To Get Sued By a Nursing Home: Negligence

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

Related posts:

1. Doing Nothing Just Cost You $9,464 (and counting)
2. Think Twice Before Giving Away Your Home
3. Estate Planning For Title 19

There can be a lot of anxiety when a loved one is in a nursing home and your assets are dwindling at the rate of +$9,000 every month. Unfortunately this anxiety can also lead to poorly informed decisions. Some families I meet come to me with an estate plan that disinherits a loved one that is in a nursing home or on Connecticut Title 19 Medicaid. The logic of this plan is to protect the family assets from being wiped out. This is a knee-jerk reaction that creates more problems than it solves in my opinion.

What can go wrong?

Many times I have family members contact me because a parent has disinherited the other parent (living in a nursing home or diagnosed with dementia) with the understanding that one child or all the children would actually use the funds to provide care for the surviving parent.

The first issue is that such an arrangement is almost non-existent on the scale of enforceability. At best there could be an oral trust but one side of the oral contract is deceased and if there is a conflict it is obvious that the other side of the contract (the child who received the funds) is saying there is no contract. Where is the evidence? At worst, the funds received by the child or children are treated as they look, outright bequests with no strings attached.

A second issue is liability concerns. The funds you intend to care for the surviving parent are now exposed to the liabilities of the person chosen to hold the funds. Common liability risks include divorce, bankruptcy, or even a car accident.

A family with a loved one in a nursing home or on a government benefits program has a choice. Disinheritance is not the only option. Disinheritance is not the preferred option and the government even recognizes this fact by providing specific protection to specific estate planning strategies.

A Special Needs Trust allows you to leave a legacy of care for a loved one in a nursing home without handing over everything to pay nursing home bills. It is absolutely critical that this unique planning is done by an experienced Connecticut special needs attorney because these trusts are reviewed by government benefits agencies and in Connecticut they are usually reviewed by the Attorney General’s office. One mistake in the document and the assets of the trust could be used to pay for bills you did not intend to pay.

I have seen too many families torn apart by using disinheritance as asset protection. There is no need for it. You have a choice. Put your plan on paper and leave your family with some security.

Related posts:

1. Critical Medicaid Mistake #1
2. The Special Needs Trust – How to Secure the Future for Your Disabled Child
3. Critical Connecticut Medicaid Mistake #3