Planning for ALF/Skilled Nursing Care Begins Before a Crisis

LEGALLY SPEAKING Planning for ALF/Skilled Nursing Care Begins Before a Crisis

BY MICHAEL FELDMAN

As an elder law firm, our office frequently assists clients with qualifying for Medicaid or Veterans Administration benefits to help defray the cost of assisted living (“ALF”) and skilled nursing (“SNF”) care. Without such assistance, seniors are often unable to meet their care needs without wholly depleting their hard-earned resources, leaving themselves destitute and reliant on children or other family members to subsidize these expenses (which can reach six figures per year for skilled nursing care).

Medicaid and VA planning comes in two forms: “long term care” planning and “crisis” planning. Long term care planning begins before the client requires ALF or SNF care (often years beforehand) while crisis planning only starts once the client is faced with imminent out-of-pocket payments for their care in a facility. The goal of both of these types of planning is to allow qualification for public benefits while protecting as much of the client’s resources as possible.

As one may expect, long term care plans generally offer the possibility of protecting more of the client’s assets, as there is a window of opportunity to implement a plan before benefits are needed. Crisis plans, however, are often started while the client is “bleeding money” each month to pay for their care, in addition to being undertaken at periods of maximum stress and anxiety for the family. Crisis plans are also by necessity undertaken on an emergency basis and may therefore be more expensive to implement than a long term care plan.

How a client’s assets can be protected and they may qualify for benefits typically involves one or more of the following methods: 1) a spend down of assets on beneficial goods or services, 2) a transfer of assets to one or more individuals, and 3) a conversion of assets from a “countable” to a “non-countable” resource (thus preserving the asset while allowing benefits eligibility). There is often overlap in the protection methods available for the two types of planning, although many of these methods are only appropriate in certain circumstances. Medicaid and VA planning is not a “one size fits all” endeavor, and one of the most important aspects of our planning services is properly advising clients which planning tools are most beneficial for their particular situation. Each type of plan must also provide a solution should the client’s income exceed the allowable amount for benefits eligibility.

Part of any plan is ensuring that the client has executed up-to-date, properly drafted advance directives, which will allow another person to make decisions for the client and otherwise handle their affairs if the client is unable to do so. These advance directives include a power of attorney, healthcare surrogate designation, living will, and several others (including a brand new advance directive -- Social Security form 4547, which allows advance designation of a Representative Payee to handle a recipient’s Social Security payments). Without these documents, it may be impossible for family members to easily engage in benefits planning for an incapacitated individual. Waiting until a crisis to put these documents in place may be too late if the individual requiring care is ill, incapacitated, or otherwise unable to execute them.

As with most cases in life, advance planning is often easier, cheaper, and less stressful than waiting until a crisis.

Feldman & Feldman counsellors at law, p.a. elder law • special needs law estate planning & administration

2020

Member of Florida, New York, and New Jersey Bars

(954)227-7320

5491 N. University Drive • Suite 102 Coral Springs, Florida 33067

www.feldmanesq.com

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