Caregiver Tip of the Month

— To Be Old, Frail and Evicted: Patients at Risk —

That was the headline of a recent article in The Wall Street Journal. The article went on to say:

"Across the country, nursing homes are forcing out frail and ill residents. While federal law permits nursing-home evictions in some circumstances, state officials and patient advocates say facilities often go too far, seeking to evict those who are merely inconvenient or too costly. Residents with dementia or demanding families are among the most vulnerable, particularly if ... they depend on Medicaid to pay their bills. ..."

"Residents may not know they can appeal or may be too ill to do so or fear retribution."

— How Can I Keep That From Happening to My Parent? —

The following story will help you understand just what a nursing home can and CANNOT do.

Situation. "My father lives in a non-profit care facility (nursing home). It says that it will keep him when he runs out of money. It is a wonderful place and they treat him very well. He has no assets and is hiding none. He has dementia and is very confused. He is angry and upset a lot. Could they tell me he can't be there anymore? If so, do they have to help me find a place for him or would they be required to find a place? He will run out of money in about 6 months."

Facts. Most (if not all) nursing homes have the legal right to discharge a patient for a variety of non-financial reasons, including being a threat to the safety of other patients and/or the nursing home's staff. But, that usually doesn't happen. Instead, depending on the laws of the state where your father lives, the nursing home may restrain him chemically (with sedative drugs) or with physical restraints. To learn if and under what conditions your father can be discharged or restrained, read the contract you (or he) signed when he was admitted into the nursing home, together with any amendments that you (or he) may have signed later.

The contract will also spell out what assistance, if any, his current nursing home will provide in finding another nursing home if they (his current nursing home) discharge him. In most cases, you will receive no help; you'll have to find a new nursing home on your own. However, most nursing home contracts state that they must give your father (or you) at least 30 days notice in writing in advance of the date when they want to discharge him.

Regarding the financial aspects of your father's situation: If someone already lives in a nursing home when they run out of money, the nursing home cannot throw them out – in most cases. However, when he does run out of money, his nursing home may require him (or you on his behalf) to apply for Medicaid to avoid being discharged. (Medicaid is the federal/state program that pays about half of all nursing home expenses.) Once again, this will be spelled out of the contract signed with the nursing home when your father was admitted.

(Another reason for applying for Medicaid when his money runs out: It will pay for the medical care he receives outside the nursing home, including office visits with medical specialists, lab tests and exams, hospital stays, etc. If that type of care is now being paid for by Medicare, his Medicare coverage will stop when he runs out of money if he has not applied for and been accepted by Medicaid.)

In 1999, Congress passed Public Law 106-4, "Nursing Home Resident Protection Amendments of 1999." In summary, the federal law says:

1. If a private-pay or Medicare patient lives in a nursing home while the nursing home is a Medicaid provider (most are), he or she cannot be discharged for financial reasons, even if the nursing home later withdraws from the Medicaid program, but continues to provide nursing home care to other types of patients. HOWEVER, nothing prevents the nursing home from moving the patient, without his or her permission, into a lower-cost room, including a ward-type room for several patients, or a special Medicaid section of the facility. But, the nursing home cannot transfer the patient to another nursing home without his or her specific permission.

2. A Medicare or private-pay patient who enters a nursing home when the nursing home is not in the Medicaid program can be discharged [evicted] when he or she is no longer able to pay the charges of the facility, even if the patient then qualifies for Medicaid. But for this type of discharge to be allowed, the nursing home must have informed the patient of this discharge [eviction] policy in writing, and received the patient's written acknowledgment, when the patient began residence in the facility.

As you can see, there are several "ifs" involved, including whether or how soon your father (or you on his behalf) should apply for Medicaid. We recommend that you discuss it at your earliest opportunity with an attorney who specializes in elder law. Check the yellow pages in your local telephone directory, or go to the National Academy of Elder Law Attorneys' website. On their home page for the public, you'll find a link in the upper left corner (just below their logo) that will help you locate an elder law attorney.

A final word of advice: While you and other members of your family may be able to help your father financially, be very careful about accidentally becoming a co-signer for any of his debts, or signing any other type of document where you agree to become financially responsible for him. If you were to become a co-signer or become financially responsible, you would be legally obligated to use your own money to pay his bills.

If you do have to sign something for your father as his Power of Attorney, make sure that you include POA after your name AND that you also sign his name after yours. That isn't forgery as long as you do have a valid Power of Attorney. And, acting as his Power of Attorney does not obligate you to use your personal funds to pay his expenses.

Find Eldercare for Your Loved Ones

We have partnered with ElderCarelink to help you find the right local eldercare services for your loved one. ElderCarelink has established a nationwide network of carefully screened eldercare providers and facilities. We are pleased to bring this referral service to you free of charge.

Within minutes of completing a brief Needs Survey, you will receive a detailed email report that list eldercare providers in your area who match your specific requirements. Last year alone, over 100,000 families utilized this service in their search for high-quality senior care.

We look forward to our family helping yours. Take a minute now to complete the Needs Survey and find the community that meets your family's needs. Let us assist you.

Our visitors ask ...

Q. My mother is an Alzheimer's patient in a nursing home and my dad is still at home. He has the early stages of Alzheimer's but is able to stay at home and manage semi-satisfactorily. However, his memory is about as long as a blink of the eye. He is constantly bombarded with requests for donations from all sorts of organizations requesting money. He says he isn't donating but he is every month. Is there a way to prevent his name and address from these organizations? I know this is not a unique problem and I am sure other families of aging parents have experienced this problem. Can you help me?

A. The Direct Marketing Association has a new "do not" list, the "Do Not Contact List for Caretakers." This is supposed to block mail, emails, and telemarketing calls from all of the association's members. For more information about that list, take a look at the Do Not Call List page from our companion website, Today's Seniors.

Daily Living Solutions

— products for seniors and the elderly —

As we grow older, it often becomes difficult to use many everyday products because of arthritis, disability or other conditions. If you or a loved one needs a little help – or a lot – here are practical and affordable solutions that make life a little easier – solutions that help people continue living independently in their own home. To help you find what you need, everything is sorted into convenient categories in our Solutions for Seniors section.

You will also find, usually at a substantial discount, hundreds of medical equipment items, home health care products for the elderly, disability assistive devices, and more.

Whether you are looking for yourself or a loved one, Solutions for Seniors offers a wide variety of products, supplies and accessories – raised toilet seats, safety rails, incontinence supplies, large-handle eating utensils, pain relief, diabetic supplies, pill splitters and crushers, big-button hearing-amplified telephones, canes, walkers, rollators, wheelchairs – and much more.

Caregiving – Finding the money for care at home

A variety of resources can help pay for care at home. We discuss these resources in some detail in our article 14 tips to help you find money (and free resources) for care at home.

Caregiver Tip #2

— How to Pay for Assisted Living: Another Option —

A lot of people are feeling more than a little uneasy about the current economic situation. The experts can spin it any way they like, but the truth is staring us right in the face. Times are tough and getting tougher. From the looks of it, we won't be digging out of this hole anytime soon.

• Foreclosures continue to break records — month after month!
• Banks are unloading homes for as little as 1/2 as much as they were worth just a few years ago!
• Gasoline prices are near all-time highs!
• Unemployment is going up!
• Inflation is rising faster and faster!
• Stocks are in a bear market — and probably going even lower!
• Loan interest rates are going up!
• Consumer credit is drying up!
• Banks are failing!
• Home prices continue to sink!

The bad news is everywhere. Chances are, you know someone who is having to make some tough decisions when it comes to money. It might even be you.

While experts debate how long it will take for the economy to find its footing, seniors who want or need to move into assisted living are up against the wall when it comes to paying for the care they need. As a result, they've started to look beyond traditional sources of funding for smart alternatives.

Seniors have typically paid for assisted living by supplementing their income from savings or investments, selling their homes, or both. But, with home prices down, selling now could translate into a substantial loss, even if a buyer can be found (selling a home now takes much longer, often more than a year). And, with stock prices down for who knows how long, selling an investment now could also result in big losses.

This is sobering news for someone who is trying to ride out the bad times and regain that value later. But waiting is not always possible, especially when you need assistance with activities of daily living now, not three years from now.

Reverse mortgages have become more common, but this option works only for a homeowner who receives care in his or her home for the rest of their life. If they have to move into assisted living or a nursing home at a later point in time, they could be faced with serious problems, including the requirement to pay back their reverse mortgage within one year after moving.

So, with the usual options off the table for now, and probably for the next few years as well, what does someone do if they have to move into independent living, assisted living, or a nursing home — NOW!

Fortunately, many seniors do have another option. When they were younger, many purchased life insurance policies as their situations in life changed — children were born, income (and lifestyle) increased, a business was started — to name just a few. Now that they've retired, however, their life insurance needs have probably changed. In other words, they're still paying for life insurance that they no longer need.

Instead of canceling the insurance just to save a few premium dollars, these "surplus" policies can be used to fund the independent living, assisted living, or nursing home care that's needed now, preserving many of their primary assets as part of the family estate, or until it more convenient to sell.

This option is called a Life Settlement. For many people, it has become a very valuable financial tool.

A Life Settlement is simply this: A policyholder sells his or her life insurance policy to an institutional investor. Typically, these investors pay a lot more policies than their cash "surrender" values. Because most life insurance values are guaranteed and disconnected from the economy, there is no fluctuation, as is the case with real estate and stocks. And, almost every type of life insurance contract can be used for a Life Settlement.

"Life Settlements are not complicated, with transactions often completed in 30 to 60 days," explains Chris Orestis, principal, Life Care Funding Group, a firm that specializes in insurance matters and Life Settlements.

A Life Settlement is an alternative way for seniors to tap into an existing asset to generate liquidity to cover immediate needs. The seller of the life insurance policy gets a lump sum payment. Since it is not a loan, the funds are unrestricted and require no repayment. The gains of a Life Settlement can be tax deductible if used to pay for assisted living or skilled nursing care. (Talk to a qualified tax accountant to learn how deductibility applies to your own situation.)

For people intimidated by the thought of selling their home or liquidating other assets to secure the funds they need, a Life Settlement is a welcome alternative source of funds, according to Orestis.

"With billions of dollars worth of life insurance owned by people older than 65 today, tapping into Life Settlements as an alternative funding option for senior housing and care is gaining serious interest," he said.

Life Care Funding Group can be reached at lifecarefunding.com

Our visitors ask ...

Q. My Mom and Dad divorced 15 years ago after being married for 31 years. He later remarried and passed away last year. She's now 78, lives in an assisted living facility, and for the most part, is mentally OK. Every year, the facility keeps increasing their fees and she's on a fix income. It's getting tougher and tougher to pay her bills. I know that his widow is entitled to his Social Security benefits, but isn't my Mom also entitled to some benefits because of their long marriage? She never talked to Social Security about it.

A. Because your Mom and Dad were married for at least 10 years, she qualifies for the larger of:

1. a benefit based on her own work history, OR
2. a benefit as a divorced spouse (one-half of your father's benefit even though he has passed away).

If the benefit based on her work history is larger, she will continue to receive that benefit, adjusted each year for inflation, for the rest of her life.

On the other hand, if the divorced spouse's benefit is larger, she will begin to receive that amount as soon as it is approved by Social Security. She will also be entitled to a lump-sum payment for all of the prior months that she was eligible for spouse's benefits but didn't collect them. Generally speaking, the amount of the lump sum will be the difference between what Social Security actually paid her based on her own work history and what she should have been paid as a divorced spouse.

Recommended Reading and Videos

Many excellent books and videos can help guide you through the caregiving process. For our recommendations, including a brief description of each one, click here.

The material on this site is for informational purposes only, and is intended as a supplement, not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider. More