Needham, MA
Estate planning Lawyer at Needham, MA
Practice Areas: Estate Planning, Elder Law ... +2 more
OUTCOME: Protected the home and savings from the cost of nursing home care.
George and Mildred have been married for over 65 years, they are both in their late 80's and came to me for recommendations regarding the potential need for long-term care. We were able to protect Geo ... rge and Mildred's home and savings from the potential cost of nursing home care.
OUTCOME: We were able to help Jenny in the nick of time and had a good outcome!
Jonny and Jenny are a couple whose quality of life and long-term care was directly and negatively impacted by avoiding planning until it was nearly too late. We see cases like this in our office all t ... he time. Jonny and Jenny, ages 72 and 65, are in trouble. Jenny and family frantically contact the office because Jonny, who suffers from progressive dementia, is now in a nursing home for rehabilitation following a fall and hospitalization for a broken hip. The facility emails Jenny that Jonny’s Medicare payments will terminate because he can no longer “progress” and he will now have to privately pay at the rate of $12,500 per month for his long term-care. Jenny has no choice but permanent placement in a nursing home. The couple o not have enough money to pay $12,000 for very long without leaving Jenny “poor.” Jenny and the family arrive in the office for help. They don’t understand what the nursing home emailed Jenny because they believe that Jonny’s Medicare should indefinitely cover his long-term care in the facility. The first thing we have to tell the family is that Medicare does not cover permanent long-term care; we will need to explore other avenues for Jonny’s support and for Jenny’s well being. Medicare coverage may be available for up to 100 days in a nursing home, with a co-pay required after 20 days. First, we review the Medicare situation to determine if Jonny’s Medicare coverage was terminated prematurely by the facility, and if so, whether that decision can be appealed to give Jonny more time for coverage. We know that Jonny was covered for about 14 days when Jenny received the termination notice via email. We tell Jenny that the legal standard for termination notices is not to provide them through a casual email. There is a specific written notice that must be given to Jenny as Jonny’s representative, which would provide a short turn around date for an appeal. We then inform Jenny that the standard is not “failure to progress” but rather, the completion of a program that returns Jonny to the condition he was in prior to the fall he suffered. Thus, if Jenny decides, she may appeal the Medicare decision to another level of review. This kind of appeal is not easily won, but it is her option to pursue. It will not resolve the ultimate issue, which is coverage for Jonny’s long-term care. We let Jenny know that it would be more productive to set up a last minute plan to save this couple’s assets and enable Jenny to continue in her lifestyle while Jonny receives the care in the nursing home that he needs. We create this plan and assist Jenny with its implementation. Jonny is now on Medicaid (MassHealth) in the nursing home and the entire family is very relieved. Jenny just wants to put all this behind her. As she describes it, she is now living like “a widow with a husband” and needs to deal with that reality. She thanks us profusely and believes she is “done” with everything. But we at Lannik Law do not agree. Now that Jenny is settled, we need to work with her on planning to avoid a similar emergency situation that would now fall to her kids to resolve. At our last meeting regarding Jonny’s planning, Jenny agrees to engage us to complete the job. She knows now that if she and Jonny had visited us sooner, their plan would have given her and Jonny peace of mind and an even easier lifestyle because it was created in a timely manner. She tells us that the plan we create for her is now her gift to her family. They will not have to go through the same problems with her that they all worked through with Jonny. So, if you want to give your family a gift, or if you are concerned about your parents, give us a call. You, like Jenny, will not regret taking action before it is too late.
Ad
Transform legal challenges into solutions.
Connect now to review your situation.
