Voters Want Long Term Care included in Presidential Candidates' Healthcare Proposals

Genworth Financial, Inc. convened a national symposium of noted experts from the healthcare industry, seniors organizations, government and academia on Capitol Hill to discuss the future of long term care in America. It also released the results of a new poll on the importance of long term care in the 2008 elections and a new book on the future of long term care in America.

Representatives from organizations such as AARP, the American Association for Homes Services for the Aging (AAHSA), the American Health Care Association(AHCA), the Alzheimer’s Association and the National Alliance of Caregivers (NAC) participated in an exchange of ideas and solutions aimed at addressing the looming crisis America faces amid rising long term care costs and a lack of sufficient planning at the national, state and individual levels.

“It is estimated that 60% of those over the age 65 will require a form of long term care at some point,” said Buck Stinson, president of Genworth Financial’s long term care insurance division. “With the first of the 78 million baby boomers turning 62 next year, we need to be both realistic and prepared for the healthcare demands many of these Americans will have, which is precisely why the discussion we’re having today is so important.”

According to the new bi-partisan national survey, nearly seven in ten Americans have not made any plans for their own, a spouse’s or another relative’s long term care needs. Yet, over half those surveyed have had a loved one who needed some form of long term care. The poll also found that close to 80 percent of the respondents want to see long term care included in the healthcare proposals offered by the presidential candidates. More than 80 percent of those surveyed also said that positions on long term care funding will be an important factor in deciding who to vote for in the 2008 election.

The polling also showed that Americans are willing to bear part of the responsibility to develop a national long term care program, whether through tax incentives for the purchase of private long term care insurance or through a universal healthcare initiative that include long term care coverage. Sixty percent of voters surveyed supported new taxes or payroll deductions to subsidize a long term care program. Sixty-eight percent of those who supported new taxes or payroll deductions also indicated a willingness to pay between $25 monthly and upwards of $50 per month.

The release of a new publication, The Future of Long Term Care in America: Views and Recommendations by Prominent Experts, was a focal point of the symposium. The book’s purpose is to inform policy makers, academics, financial advisors and consumers about the challenges of long term care. It will be available on Amazon.com. It is comprised of ten chapters, each written by a different author such as AARP CEO, Bill Novelli, and former Congressional Budget Office Director, Douglas Holtz-Eakin. It covers a wide range of long term care issues including the role of technology in future care, Alzheimer’s disease, independent living, public funding for long term care programs, the growing demand and delivery (home-based and facility-based) of long term care services and other relevant topics. More information about the book, including a full list of chapters and their authors, can be found at Genworth.com.

Source: CNNMoney.com; 10/11/07

New Medicare Premium, Decuctible & Coinsurance Charges for 2008

The Centers for Medicare and Medicaid Services (CMS) has announced the new Medicare premiums, deductibles, and coinsurances. The standard Medicare Part B premium is increasing by 3.1 percent to $96.40 a month, the smallest increase since 2001.
The increase is lower than previously expected in part due to the correction of an accounting error. Money for certain hospice benefits had been inadvertently drawn from the Part B trust fund rather than the fund that pays hospital costs. In addition, the lower premium assumes that physicians will take a 10 percent cut in their reimbursement rates. It is expected that Congress will act to offset some of or all of that pay cut, meaning that future-year premiums will reflect the additional expense.
Here are all the new Medicare figures:
Part B premium: $96.40/month (was $93.50)
Part B deductible: $135 (was $131)
Part A deductible: $1,024 (was $992)
Co-payment for hospital stay days 61-90: $256/day (was $248)
Co-payment for hospital stay days 91 and beyond: $512/day (was $496)
Skilled nursing facility co-payment, days 21-100: $128/day (was $124)
As directed by the 2003 Medicare law, for the first time, higher income beneficiaries will pay higher Part B premiums. Following are the higher premium rates:
Individuals with annual incomes between $82,000 and $102,000 and married couples with annual incomes between $164,000 and $204,000 in 2008 will pay a monthly premium of $122.20.
Individuals with annual incomes between $102,000 and $153,000 and married couples with annual incomes between $204,000 and $306,000 in 2008 will pay a monthly premium of $160.90.
Individuals with annual incomes between $153,000 and $205,000 and married couples with annual incomes between $306,000 and $410,000 in 2008 will pay a monthly premium of $199.70.
Individuals with annual incomes of $205,000 or more and married couples with annual incomes of $410,000 or more in 2008 will pay a monthly premium of $238.40.
Rates differ for beneficiaries who are married but file a separate tax return from their spouse:
Those with incomes between $82,000 and $123,000 will pay a monthly premium of $199.70.
Those with incomes greater than $123,000 will pay a monthly premium of $238.40.
Source: www.elderlawanswers.com

Insurance Gaps & Unexpected Tragedies Leave Many Facing Impossible Choices

Many Americans retire early prior to reaching age 65 and receiving Medicare coverage. If they do not plan carefully, they will not have health care coverage before they can be covered by Medicare.

Many Americans retire early prior to reaching age 65 and receiving Medicare coverage. If they do not plan carefully, they will not have health care coverage before they can be covered by Medicare. Others become disabled, but have to wait 25 months prior to receiving Medicare coverage. Others are simply the victims of bad luck.

Consider the following:

A 59-year-old man falls from a second-story balcony and sustains severe injuries including brain damage. Unfortunately, he is without health insurance because he decided to retire before he was 65 in order to care for his wife who is stricken with Alzheimer's. How will he pay for his various medical bills?

A 48-year-old woman with two children suffers a stroke. Her employer's health care insurance includes an annual $50,000 benefit cap. How will she pay for her hospital stay and doctors' bills?

A 23-year-old woman is stricken with a brain aneurysm. She had just changed jobs following a cross-country move. Her recent job change has left her without the necessary insurance to pay for this care.

Many Americans suffer "gaps" in their health insurance coverage. A hospital stay or medical care for cancer or other similar diseases wreaks financial havoc for these families. Unfortunately, many learn too late that they have no health insurance, inadequate health insurance or very low caps on their insurance benefits. Some of them mistakenly think that Medicare will cover them if they are over the age of 65.

Most of these individuals have been self-supportive and typically paid into either a private health care insurance program or have been involved in an employer-sponsored plan. Their needs are not typically classified as long-term care needs. Often times, hospital/rehabilitation stays exceed $20,000 per month. According to the U.S. Agency for Healthcare Research and Quality, after adjusting for inflation, the average hospital charge increased by 24 percent from $13,900 in 1997 to $17,300 in 2002. Many of these individuals will be able to return to their homes and even to their jobs. Sadly, their lack of health care coverage or caps on benefits leave them in a near bankrupt position. In some cases, they may even be forced to end long-term marriages due to the financial hardship and strain placed on their families. These cases also adversely affect the dependent children of those without coverage.

These cases involve very common people with very uncommon injuries or illnesses. The result will shield companies from liability and shift the cost of care to the state Medicaid programs.

Elder law attorneys regularly recommend the purchase of health insurance for individuals who are considering early retirement or who are not covered by a group health care insurance policy. Many people do not plan ahead and purchase private disability insurance or exercise their COBRA rights to continue their employer sponsored health care insurance. Only if they suffer from an unexpected illness or are involved in an accident do they realize they were uninsured or underinsured.

A recently released U.S. Census Bureau report shows the number of uninsured people rose from 44.8 million in 2005 to 47 million in 2006. A report last year by the Robert Wood Foundation shows one in six adults between the ages of 50-64 are uninsured.

Elder law attorneys assist individuals in identifying current or future insurance coverage gaps. Elder law attorneys guide older adults, people with disabilities and families through an assessment of resources, needs and goals, so that they can cope with unexpected tragedies or plan ahead to access health care whenever it is needed.

For more information about elder law attorneys and the National Academy of Elder Law Attorneys, visit www.naela.org

Source: NAELA, Eye on Elder Issues, September 2007, Vol. 4, Issue 4.

Providing for Children with Disabilities

One of the major concerns for parents with children with disabilities is how to provide for their financial future. Here are some legal tips:


Buy enough life insurance. A parent is irreplaceable, but someone will have to fill in. In all likelihood, that person or family will have to pay for at least some services the parent or parents had provided when able. If the estate is not large enough for this purpose, it can be made large enough through life insurance proceeds. Premiums for second-to-die insurance (which pays off only when the second of two parents passes away) can be surprisingly low.

Set up a trust. Any funds left for a disabled child, whether from an estate or the proceeds of a life insurance policy, should be held in trust for his or her benefit. Leaving money for anyone with a disability jeopardizes public benefits. Many people with disabilities cannot manage funds – especially large amounts. Some families disinherit disabled children, relying on their siblings to care for them. This approach is fraught with potential problems. Siblings can be sued, get divorced, disagree on their responsibilities, or run off with the funds. It can also cause tax problems for siblings. The best approach is a trust fund set aside for the disabled child.

Will/appointment of guardian. While a will and the appointment of a guardian is important for anyone with minor children, it is doubly so if the child is disabled. Finding the right guardian can be difficult. In some cases, the care needs of the child may be so demanding that he or she will need a different guardian from his or her siblings. The parents need to make these determinations while they can. The will is the vehicle for the appointment of a guardian.
An adult child may also require a guardian when the parent can no longer serve in this role (whether officially appointed or not). It will probably not be legally possible to officially appoint a successor guardian. So, it may make sense to begin making the transition to a new guardian while the parent is able to assist in the process. This can be done in the form of a co-guardianship, or passing the baton to a successor guardian.


Care plan. All parents caring for disabled children should write down what any successor caregiver would need to know about the child and what the parent’s wishes are for his or her care. For example, should the child be in a group home, live with a parent, be on his or her own? Usually, the parent knows best, but needs to pass on the information. The memo or letter can be kept in the attorney’s files with the parent’s estate plan.

Coordination with other family members. Even a carefully developed plan can be sabotaged by a well-meaning relative who leaves money directly to the child with a disability. If a trust is created for the benefit of the child, grandparents and other family members should be told about it so that they can direct any bequest they may like to leave to that child through the trust.

Source: www.elderlawanswers.com; 9/6/07

What is Required of an Executor?

Being the executor of an estate is not a task to take lightly. An executor is the person responsible for managing the administration of a deceased individual's estate. Although the time and effort involved will vary with the size of the estate, even if you are the executor of a small estate you will have important duties that must be performed correctly or you may be liable to the estate or the beneficiaries.

The executor is either named in the will or if there is no will, appointed by the court. You do not have to accept the position of executor even if you are named in the will.

The average estate administration takes one year, though you won't need to work full time on it. Following are some of the duties you may have to perform as executor:

Locate documents. If there is a will, but you don't already know where the will is or the will hasn't already been brought to court, you may need to find it among the deceased's belongings. If all you have is a copy of the will, you may need to get the original from the lawyer who drafted it. You will also need to get a copy of the death certificate.
Hire an attorney. You are not required to hire an attorney, but mistakes can cost you money. You may be personally liable if something goes wrong with the estate or the payment of taxes. An attorney can help you make sure all the proper steps are taken and deadlines met. To find a qualified elder law attorney near you, click here.
Apply for probate. If there is a will, the court will grant you letters testamentary. If there is no will, you will receive letters of administration. This will officially begin your work as the executor.
Notify interested parties. Notify the beneficiaries of the will, if there is a will, as well as any potential heirs (such as children, siblings, or parents who may or may not be named in a will). In addition, you will have to place an advertisement for potential creditors in a newspaper near where the deceased lived.
Manage the deceased's property. You will need to prepare a list of the deceased's assets and liabilities, and you may need to collect any property in the hands of other people. One of the executor's jobs is to protect the property from loss, so you will need to assure the property is kept safe. You will also need to hire an appraiser to find out how much any property is worth. In addition, if the estate includes a business, you may have to make sure the business continues to run.
Pay valid claims by creditors. Once the creditors are determined, you will need to pay the deceased's debts from the estate's funds. The executor is not personally liable for deceased's debts. The estate usually pays any reasonable funeral expenses first. Other debts include probate and administration fees and taxes as well as any valid claims filed by creditors.
File tax returns. You need to make sure the tax forms are filed within the time frame set under the law. Taxes will include estate taxes and income taxes.
Distribute the assets to the beneficiaries. Once the creditors' claims are clear, the executor is responsible for making sure the beneficiaries get what they are entitled to under the will or under the law, if there is no will. You may be required to sell property in order to fulfill legacies in a will. In addition, you may have to set up any trusts required by the will.
Keep accurate records. It is very important to keep accurate records of everything you do. You will need to create a final accounting, which the beneficiaries must review before the distribution of the estate can be finalized. The accounting should include any distributions and expenses as well as any income earned by the estate since the deceased died.
File the final accounting with the court. Once the final accounting is approved by the beneficiaries and the court, the court will close the estate. File a final report with the court and close the estate.
All this can be a lot of work, but remember that the executor is entitled to compensation, subject to approval by the court. Keep in mind that the compensation is counted as income, so you will need to declare it on your income taxes.

Source: www.elderlawanswers.com; 8/20/07

Seniors Often Must Fight for Medicare Home Health Benefits

Medicare is mandated to cover your home health benefits with no limit on the time you are covered. Unfortunately, few Medicare beneficiaries get the level of service they are entitled to and many find their services cut off prematurely. Getting these benefits can be critically important. Medicare home health care benefits can mean the difference between being able to stay at home with a difficult medical problem or ending up in the hospital or a nursing home.

As a Medicare recipient, you are entitled to full home health benefits if you meet the following requirements:

You must be confined to your home – meaning that leaving it to receive services would be a "considerable and taxing effort."
Your doctor must have ordered home health services for you.
At least some element of the services must be skilled – skilled nursing care, physical therapy, or speech therapy.
You must receive the services from a certified home health agency.
Requiring an element of skilled care also will entitle you to Medicare coverage of social services, home health aide services, and the necessary medical supplies and equipment. You won't have to pay anything for the home health benefits, but you will have to pay 20 percent of the supplies and equipment.

Under the law, you are entitled to 35 hours of service a week, but few Medicare beneficiaries who meet the home health care criteria actually get this level of service. If your services are terminated prematurely, you will need to appeal. If you have to appeal, the good news is that most people win their cases. In fact, 81 percent are successful on appeal to an administrative law judge.

If you can you should continue to pay privately for the care during the process. Remember – the issue you are appealing is not the termination of service, but the denial of Medicare payment for the service.

In order to mount a successful campaign to get your services back, you should:

Ask your home health agency to explain the cutback and write the information down.
Ask your physician to call the agency urging them not to cut back the services and, then have the physician send a letter detailing the level of care you need.
Consult with a Medicare assistance agency or your attorney to determine the likelihood of a successful appeal.
If you decide to appeal, do so immediately and make sure you make arrangements to pay privately pending the result of the appeal.

Source: Elderlawanswers.com, 7/16/07

Should you sign a Nursing Home Admission Agreement?

Admitting a loved one to a nursing home can be very stressful. In addition to dealing with a sick family member and managing all the details involved with the move, you must decide whether to sign all the papers the nursing home is giving you. Nursing home admission agreements can be complicated and confusing, so what do you do?

It is important not to rush, but rather to read. Read the agreement carefully because it could contain illegal or misleading provisions. If possible, try not to sign the agreement until after the resident has moved into the facility. Once a resident has moved in, you will have much more leverage. But even if you have to sign the agreement before the resident moves in, you should still request that the nursing home delete any illegal or unfair terms.

Two items commonly found in these agreements that you need to pay close attention to are a requirement that you be liable for the resident's expenses and a binding arbitration agreement.

Responsible party

A nursing home may try to get you to sign the agreement as the "responsible party." It is very important that you do not agree to this. Nursing homes are prohibited from requiring third parties to guarantee payment of nursing home bills, but many try to get family members to voluntarily agree to pay the bills.

If possible, the resident should sign the agreement him- or herself. If the resident is incapacitated, you may sign the agreement, but be clear you are signing as the resident's agent. Signing the agreement as a responsible party may obligate you to pay the nursing home if the nursing resident is unable to. Look over the agreement for the term "responsible party," "guarantor," "financial agent," or anything similar. Before signing, cross out any terms that indicate you will be responsible for payment and clearly indicate that you are only agreeing to use the resident's income and resources to pay.

Arbitration provision

Many nursing home admission agreements contain a provision stating that all disputes regarding the resident's care will be decided through arbitration. An arbitration provision is not illegal, but by signing it, you are giving up your right to go to court to resolve a dispute with the facility. The nursing home cannot require you to sign an arbitration provision, and you should cross out the arbitration language before signing.

Other provisions

The following are some other provisions to look out for in a nursing home admission agreement.

Private pay requirement. It is illegal for the nursing home to require a Medicare or Medicaid recipient to pay the private rate for a period of time. The nursing home also cannot require a resident to affirm that he or she is not eligible for Medicare or Medicaid.
Eviction procedures. It is illegal for the nursing home to authorize eviction for any reason other than the following: the nursing home cannot meet the resident's needs, the resident's heath has improved, the resident's presence is endangering other residents, the resident has not paid, or the nursing home is ceasing operations.
Waiver of rights. Any provision that waives the nursing home's liability for lost or stolen personal items is illegal. It is also illegal for the nursing home to waive liability for the resident's health.

A certified elder law attorney can clarify all of your options.

Source: www.elderlawanswers.com