A nursing home stay marks a change in life. The transition is easier if you are well prepared. Of course, arranging your assets is important. And, you need a will, living will, and powers of attorney. The proper state of mind is crucial, too. Following these ten points makes the stay more pleasant and helps put your affairs in order.
1. Make it a positive experience
Like all of life’s changes, entering a nursing home can be good or bad. It is up to you to make it positive. Nursing homes work hard to present activities that entertain and educate. Take advantage of them. Participate in as many things as possible. Make new friends. A stay in a nursing home is just one more station in life. Live it for all it is worth.
2. Help the staff help you
Getting to know the staff well greatly increases the odds of having a positive experience. The nurses, aides, and administrators all want the residents to get well and enjoy themselves. If you visit often and ask questions, then they can anticipate your needs and better serve you.
3. Payment methods
The patient is responsible for paying all the costs. This includes room and board, simple nursing care, and beds and linens. Most Ohio nursing homes charge over $6,000.00 per month for basic care. The patient is responsible for paying all other costs, too. Examples are doctor visits, prescriptions, medical procedures, clothing, extra laundry, hair care, toiletries, a private telephone, and a television. Medicaid, a government program, usually will not pay unless the resident has spent nearly all of their money. Long term health care insurance can pay these costs, but a resident must have it in place before entering the facility.
4. Identify all assets
The nursing home resident should inventory all of his assets. This should specify the asset type (i.e., CD, IRA, real estate, checking account, annuity, life insurance, stock, bond, etc…), current value, and beneficiary if it is jointly held or payable on death. If the resident will pay for his costs himself (often called a “private pay” resident), then this list identifies those assets most suitable for payment. If the resident applies for Medicaid, then the caseworker will require all this data. Further, this information is necessary for proper estate planning as described in item 9.
Medicaid, in proper cases, can pay for nursing home care. This is a federal program that each state administers. Approximately 50% of nursing home residents receive this aid. A nursing home cannot treat a patient differently if Medicaid pays for their care. In most cases, to be eligible one must have a limited income and less than $1,500.00 in assets. Qualifying for Medicaid is quite technical. If you have questions, it is important to consult with a professional who is knowledgeable about the rules. One can buy some articles and make some gifts and still get Medicaid assistance. However, some purchases or gifts can cause a lengthy period of ineligibility. If you do not know the difference, then consult with an expert.
6. Financial Power of Attorney
Neither a spouse, nor anyone else, can act on your behalf unless you authorize it. Almost always a nursing home resident should have a power of attorney for financial affairs. This lets a third party, known as an attorney in fact, handle all of your assets. The attorney in fact should be someone you completely trust. The instrument gives them the power to spend all of your money. If you do not have a financial power of attorney and lose the ability to act, then a Guardianship may be necessary. You want to avoid this. Guardianships are expensive and public. They are expensive because they require a lot of attorney time. This can cost thousands of dollars. They are public because all of your income, assets, debts, and expenditures are filed with the probate court. Everybody may view the information. The attorney in fact can do nearly everything the Guardian can do. The attorney in fact, though, does not need an attorney or file anything with the court. The power of attorney can also permit the person to take actions to qualify you for Medicaid. Guardians cannot do as much to make you Medicaid eligible. Thus, a financial power of attorney is an important tool that every resident should consider having.
7. Health Care Power of Attorney
A health care power of attorney is also a must for each resident. It allows you to control who will make health care decisions if you are unable to do so. This person may view all of your medical records, consult with all health care providers, choose whether or not to have procedures performed, hire and fire doctors, obtain second opinions, deal with insurance companies, and generally make all decisions affecting your health care. The attorney in fact of a health care power of attorney can promptly give directions. A person with this authority can cut through confusion and give timely guidance.
8. Living Will
A living will is another instrument each resident should put in place. It directs health care providers to withhold life-sustaining treatment in the most hopeless of circumstances. Without it, doctors must try to save a person and fear the consequences if they do not. A living will gives clear guidance and liability protection to those persons who rely upon it. If there is no living will and death is close, then removing life support is tough. The doctors must determine which person is the legal “medical decision-maker.” Then they investigate the patient’s desires and obtain a written consent to remove treatment. Then they give a forty-eight hour notice and implement the decision. If the patient is in a coma, then Ohio law requires a twelve-month waiting period. A living will eliminates this process and provides a quicker, surer means to carry out the patient’s wishes.
9. Wills and Trusts
All adults should have a will. This determines who receives your assets and makes the process simpler and cheaper. If you do not have a will, then the state decides who gets your money. A well drafted will can also save taxes. Even if a person has few assets, a will is necessary. It allows you to name the beneficiaries who receive your most personal possessions. These could be photographs, clothing, jewelry, knick-knacks, and family heirlooms. When drafting a will, a thorough attorney also asks about the asset inventory we described in item 4. This is because a will does not control assets with beneficiary designations. Examples are IRAs, pensions, jointly held assets, annuities, life insurance, and payable on death accounts. All money in this type of asset goes to the beneficiary. The will does not control where that money goes. A proper estate plan looks at each asset and considers how each loved one will or will not inherit from a decedent. A trust is useful for more sophisticated needs. In 2008, persons with more than $2 million face a combined federal and Ohio estate tax rate of fifty percent or more. Trusts can reduce or eliminate these taxes. Also, trusts can impose conditions on receiving money. Trusts can make beneficiaries wait to receive their inheritance until they are older than twenty-one. Trusts can also require them to remain debt free or go to college.
10. Health Insurance
It is crucial to keep the health insurance in place for a nursing home resident. Nearly all medical procedures and doctor visits are not covered by the basic nursing home contract. Take all steps necessary to make sure the premiums are paid. Unlike long term health care insurance, health insurance is much more widely available. If there is no health insurance, the resident should try to get it immediately. The family should work with a competent professional to obtain coverage.
We can help
Our office has helped many nursing home residents and their families. We review all wills, powers of attorney, and trusts to make certain they remain suitable for the circumstances. While doing this, we look at every asset and beneficiary regardless of the size of the estate. We work to put in place a plan that carries out the resident’s wishes. We have helped many families to preserve assets and become eligible for Medicaid. Our attorneys take this thorough and careful approach in everything we do. If you have a legal need, then we are just a phone call away. If we do not practice in an area, then we refer to someone with a proper expertise.
There’s no charge for the first few minutes on the phone. An attorney is available at (937) 667-8805 from 8:30 to 5:00, Monday through Friday. We promptly answer messages. Voice mail is always available, or in emergencies, call (937) 667-0225.