Planning For ALF/Skilled Nursing Care Begins Before A Crisis
The cost of care in an assisted living facility (“ALF”) or skilled nursing facility (“SNF”) often approaches or exceeds $100,000/year. In order to meet these care expenses, seniors must often deplete their hard-earned resources, leaving them destitute and reliant on children or other family members to subsidize their care. As an elder law firm, we frequently assist clients with qualifying for Medicaid or Veterans Administration benefits, which can provide much-needed assistance with paying for their care needs.
Medicaid and VA planning typically takes two forms: “long-term care” planning and “crisis” planning. Long-term care planning begins before the client requires substantial care (often years beforehand) while crisis planning begins once the client is faced with imminent out-of-pocket payments for their care in a facility. The goal of both 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 and before a significant outlay of funds must begin. 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.
Protecting the client’s resources 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. The planning techniques appropriate for one client may be wholly unfit for another client.
A necessary 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 if they are unable to do so for themselves. These advance directives include a power of attorney, healthcare surrogate designation, living will, and 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.
Contact Feldman & Feldman, Counsellors at Law, P.A.
To discuss long-term care or planning with our of our elder law attorneys, schedule a consultation by calling 954-228-6074 or filling out our online contact form.