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Davidow, Davidow, Siegel & Stern, LLP
Long Island's Elder Law, Special Needs & Estate Planning Firm

Friday, March 20, 2009

Five Star Rating System for Nursing Homes

The Centers for Medicare and Medicaid Services (CMS) has unveiled a one-to-five star rating system for nursing homes to help consumers evaluate a nursing home’s quality when selecting a facility. The ratings appear on the agency’s Nursing Home Compare Website at www.medicare.gov/NHCompare. A five-star designation means the facility ranks “much above average,” four-star indicates “above average,” three means “about average,” two is a “below average” ranking, with a one indicating that a facility ranks “much below average.” The rankings, which will be updated monthly, are based on a nursing home’s performance in three areas: quality measures, nurse staffing levels and health inspection reports.

In this first round of quality ratings about 12-percent of the nation’s nursing homes received a full five-star rating while 22-percent scored at the low end with one star. The remaining 66-percent of facilities were distributed fairly evenly among the two-, three- and four-star rankings. The ratings indicate that non-profit nursing homes deliver a higher quality of care than for-profit facilities, according to an analysis by USA Today (www.usatoday.com/news/health/2008-12-18-nursinghome_N.htm). When the rating system was announced earlier this year, Toby Edelman, senior policy attorney with the Center for Medicare Advocacy (www.medicareadvocacy.org/), said that two of three criteria CMS uses for the ratings – staffing data and quality measures – are “...self-reported by nursing facilities and are inaccurate.” Edelman said, “Relying on nursing homes to describe accurately how well they are doing...just doesn’t make sense.”

The National Citizens’ Coalition for Nursing Home Reform issued a statement (www.nccnhr.org/uploads/File/Ombudsman_statement_on_Five-Star-Release.pdf) saying it commends CMS for providing a new tool for long-term care consumers but urging consumers to “...not oversimplify nursing home selection.”

“In reviewing the Five-Star rating for a particular nursing home, consumers should compare the rating with their own experience during a personal visit to the home,” the Coalition warned. “For example, staffing data that is used for the rating system is based on the two weeks prior to the nursing home’s annual regulatory survey, an insufficient period of time to represent the usual staffing pattern of the home. Consumers should visit the home and review staffing data that is required to be posted for every shift, every day.”

For its part, the nursing home industry is not pleased with the rating system. In an opinion piece in USA Today, Bruce Yarwood, president of the American Health Care Association (www.ahcancal.org/Pages/Default.aspx), a long-term care industry trade group, called the new rating scheme “...a complex and inaccurate system that fails to provide the consumer with an appropriate tool to measure quality of care in our nation’s nursing homes.”

Source: 50+ Lifestyles, February 2009.

Elder Law and Estate Planning Seminars: TIME IS RUNNING OUT!
Thursday, March 26th at 10am at The Miller Place Inn OR Tuesday, March 31st at The Milleridge Inn. Call 631-234-3030 to reserve your seat for the seminar and lunch.

Monday, March 16, 2009


When creating an estate plan, an important decision is who to name as your fiduciary. A fiduciary is a fancy legal term for the person who will take care of your property for you if you are unable to do it yourself, such as the executor of an estate, the trustee of a trust, or an attorney-in-fact under a power of attorney. Your first instinct might be to name one of your children as a fiduciary, but if you want to avoid conflict among your children, this might not be the best option.

When naming a fiduciary, it is important to be able to trust the individual, which is why people often name family members as fiduciaries. However, problems can arise when a parent with two or more children names one child as a fiduciary. According to Tim O’Sullivan, an attorney from Wichita, Kansas, who spoke on the issue of family harmony at a recent conference for elder law attorneys, a child is often not the best fiduciary for several reasons:

- It is hard for a child to be completely objective.
- Children often disagree over many things, including how long the estate should take to complete, the selling of assets and the division of personal property.
- Children often don’t communicate with each other well.

O’Sullivan says that, in his experience, when one child is named as the fiduciary, problems arise between family members about one-quarter to one-third of the time.

An alternative is to hire a professional fiduciary. A professional fiduciary can be a bank with trust powers, a certified public accountant, or a trust company. The attorney who is drafting your estate planning documents can recommend a good one in your area. A professional fiduciary will charge a fee, but the fee should be explained ahead of time. In addition, because a professional is experienced in managing money and property, your assets are more likely to increase under this person’s or institution’s guidance.

To ensure that your family has some input, you an include a provision that allows one or more family members to discharge the fiduciary if they feel the professional is not doing a good job. This will allow your family to make sure the fiduciary is performing properly without having the burden of acting as fiduciary.

Source: www.elderlawanswers.com, 2/3/09

Friday, March 6, 2009

VA to Repay Vets for Care

The Department of Veterans Affairs, stung by criticism that its slow action has forced some severely disabled veterans to spend themselves into poverty, has moved to implement a two-year-old law requiring it to reimburse such veterans for the cost of care at state-run nursing homes.

The VA sent letters to the nation’s 137 state veterans nursing homes – including ones in Stony Brook and St. Albans, Queens – saying they expect to begin processing reimbursements within 90 days. A bill signed into law by President George W. Bush in 2006 required the VA to reimburse the full cost for veterans with a 70 percent or greater service-connected disability who require nursing home care.

But although Congress specified that the law be implemented by March 21, 2007, the VA still has not begun issuing payments. A VA spokesman said no one was available to explain the two-year delay. The holdup has forced some elderly veterans to spend away their life savings before they could qualify for Medicaid payments to cover the $250-per-day cost of care at the Long Island State Veterans Home at Stony Brook University.

At least eight patients at Long Island State Veterans Home who would have been covered under the law have been forced to pay for some or all of their care out of pocket, according to Sen. Charles Schumer, who visited the nursing home last month. Two of the veterans have died while waiting for the law to come into effect.

About 80 percent of patients at the nursing home are on Medicaid, a hospital official said.

Some 4,800 Long Island veterans are more than 70 percent disabled and become increasingly likely to require nursing home care as they get into their 80s and 90s.

Long Island State Veterans Home director Fred Sganga said he was encouraged, but remains cautious. “We’ve been promised this won’t take more than 90 days,” he said. “But it’s not over until it’s over.”

Source: Martin C. Evans, Newsday, Wednesday, March 4, 2009

Davidow, Davidow, Siegel & Stern is dedicated to educating veterans to their rights and entitlement options in an effort to finance their long term care. As we read about the circumstances detailed in the above article, we can’t help but feel that this could have been avoided. Forcing a veteran, that has other options available, to spend themselves into poverty to finance their long term care is completely unnecessary. This is the reason we have been committed to getting the word out on another type of Veteran pension benefit that could also finance long term care. This under-used, special monthly pension benefit called Aid and Attendance, upon eligibility approval, could provide veterans with up to $1949 a month to help pay for long term care either at home or in an assisted living facility. Many veterans do not know this pension exists! We are accredited through the Veterans Administration to guide veterans and their families through the complicated process of obtaining this benefit. Come in to find out how we can help make a difference in a veteran’s life.