I have a small request to ask of you… and a gift for you if you’d like to grant that request. But before I tell you what it is, let me go over what the gift is all about.

One of the biggest challenges caregivers face is making sure that their loved one gets the best care, wherever they are.

We’ve all heard the worst-case scenario stories of elder abuse and other horrors befalling seniors in facilities.

But what you may be worried about is simply that your loved one will be lonely, ignored, or feel forgotten.

You desire to know that your loved one will be given tender loving care, get social interaction, and is surrounded by people who care not only for their body but for their soul.

I’m here to tell you there are things you can do to make a fulfilled existence for your loved one a reality.

Many nursing homes have a family council that meets regularly to deal with issues that arise in the nursing home.

This can be a huge help to loved ones and caregivers – but what if the nursing home in which your loved one resides doesn’t have one? How can you get one started?

Family councils are very beneficial if they are set up and facilitated properly.

The goal of the meetings is to talk about issues of the home with the staff in a non-threatening, constructive atmosphere.

It is not a place to complain or to degrade the facility or staff. Instead, at meetings you can share ideas, concerns, and possible solutions. And you can bond with the staff and develop working relationships with them.

If a council doesn’t already exist, talk with the administrator of the facility about your desire to create this council.

You will most likely not face much resistance, as these councils are common practice. Decide together how to proceed, where to meet (what room is available), what day and time to meet, who should facilitate the meeting, and how you will inform staff and family members of the meetings. When you have your first meeting, talk with the other families about the best time to meet, and you can decide as a group.

Your meetings can be formal, with minutes, or less formal. The structure isn’t as important as how information is shared.

Another function of the family council is to arrange facility activities that include residents and their families. These activities are usually picnics held at the facility. These functions help encourage the feeling of a family unit for residents, staff, and families.

How can you find out how to get the best possible treatment for your loved one with Alzheimer’s?

Well, fortunately, my guide “How To Choose The Right Nursing Home And Ensure Your Loved One Gets Great Care” reveals a tremendous amount of hard to find insights and practical guidance in this very area.

In this guide you’ll discover:

- My special Nursing Home Evaluation Form, which gives you dozens of special considerations that most people never think about to help you choose the right place
- 3 steps to make the transition go smoothly
- 1 big secret on how to connect with staffers so that your loved one gets the best treatment.

This guide is available at no charge. All I ask is that you take 2 minutes out of your day to tell me about your most urgent, burning question. What’s the one thing you’d like to know more about or wish you could change? What’s keeping you up at night?

Hearing what’s most important to you will help me to assist you, and so many other caregivers like you.

Then, click the link below to find out more about how to get your loved one the best care in my nursing home guide.

www.AlzheimersResourceKit.com/hammond/resources/findgoodcare.html

I got a letter from my client Theresa last week.

She wrote:

As you know, last summer I entered Mom into the nursing home. Her Alzheimer’s progressed. In the home, she’s physically active, social, and of course, her memory is lacking.

As she greets and visits with the other patients, she often takes off her glasses. The nursing home staff keeps a watchful eye for her misplaced glasses.

Unfortunately, she still loses her specs.

Sometimes she takes off her glasses and leaves them on the dinner tray. We lost at least one pair that way. Just a few months into the New Year, I’m now replacing her third pair.

Replacing her eyeglasses with their special prescription requires a bankroll.

With Medicaid limiting Mom’s personal monthly income to $30, I’m so relieved you helped me set up protections so there is money left over to pay for them. Mom’s bifocals cost a mint. With her tiny nose, she requires costly lightweight eyewear, otherwise she suffers with headaches. Her frames would NEVER be covered under Medicaid.

I’m so grateful we have money from the trust available so she can afford to live her remaining days comfortably. Without the planning we’d done with you, she would have to wait until I had funds to cover her expenses.

* * *

Theresa is not alone.

Many of our families face ancillary fees that can add up quickly.

Some of common expenses when your loved one is in the nursing home are hearing aids, dentures, hair appointments, nail manicures and pedicures, and sometimes transportation costs (to your house for dinner, dentists, or doctor appointments). It doesn’t take much for the costs to really add up.

Alzheimer’s patients frequently lose personal items like eyewear and dentures. These items need replacing immediately.

To help ensure quality of life for your loved one, you need money available to cover these expenditures. To save some of your loved one’s money from being spent on care, it’s a complicated process. It’s likely you need some solid advice and a well thought out plan. That’s where we can help.

We work with our clients’ families, so they can legally set money aside for these types of expenditures.

Unfortunately, most families are not aware of the sensitive timelines to set up this type of legal asset protective structure. The sooner planning begins, the more an attorney is likely to be able to save.

Once your family member applies for Medicaid to help cover medical costs, the government conducts the audit on your loved one’s accounts. The government can claim that any gifts an individual made were intended to help them qualify for long term care if it falls within the five-year period.

When you select a legal advisor, it’s important for you to work with someone who understands elder care law. Select an attorney who focuses in this area.

State laws constantly change, especially now with many states managing deep deficits.

State and federal governments are always looking for ways to slash Medicaid coverage.

When you select an attorney to help set up a plan for yourself, it’s important the attorney is intimately knowledgeable about the fine lines of the state laws so your money is protected and spent in a way that will not get you penalized in the future.

Something else to consider: planning is much better for all parties while the person still has the capacity to make their own decisions.

We provide our clients a free phone consultation. If you would like to find out more about how to put legal structure in place to protect and set aside funds so your loved one can maintain a good quality life while in a nursing home, feel free to contact me at (913) 338-5713.

If we cannot help you, we’ll direct you to resources that can. The call is free; don’t miss this opportunity to gain valuable insight.

We know that Alzheimer’s can be a debilitating disease, and when it takes hold, often it becomes necessary to seek nursing home care. Yet in married couples it is common that one spouse remains perfectly healthy while their partner declines; and in that case, only one of them needs that care. How can half of a married couple qualify for Medicaid? In short, they must go through a process called Division of the Assets.

Consider this: a couple is married, and the husband has Alzheimer’s. The wife has been his care giver, but it has gotten to the point that she can no longer adequately care for him and for herself, for any of multiple reasons. So she places her husband in a care facility, but then must figure out how to pay for it. In Kansas City, that cost, especially for memory care, can be anywhere from $6,000-$6,500 a month—sometimes more, and few families can afford to just outright pay upwards of $60,000 dollars a year. For a while, the couple can choose to “private pay” by simply writing a check to the facility with money they’ve already got. If the couple was fortunate enough to secure long term care insurance, that will go towards that cost of care for a while, but for most clients of the Elder and Disability Law Firm and others like them, what ultimately happens is that they come to a point that they can no longer pay that fee out of pocket. In those cases, they then go through a process to qualify one partner for Medicaid, through a process called Division of Assets.

Say our couple has $100,000 in the bank. The state would review the assets and would say certain things are exempt from what are called the “countable assets”, meaning that the monetary value of those things does not count against the ultimate amount that the state dictates an individual or couple can have. Namely these exemptions include a house, a car, a prepaid funeral plan for both spouses, $1500 cash value life insurance or term insurance, and household goods: furniture, clothing, appliances. All of these items are exempt, but everything else would count in the state’s review of the assets. The next step then is to put half of those total banked assets (in our case, half of $100,000) on the side of the spouse who needs care, the husband, and the other half on the side of the one who’s remaining at home, the wife. So the husband has, in this example, $50,000 of assets. He would have to spend that money down until it went (in Kansas) to $2,000 or (in Missouri) less than $1000. Once that money had been spent down, he would then be eligible for Medicaid and his wife would be allowed to keep her half of the assets and a certain amount of income.

Spend down? What is it okay to spend that money on?
Certain things are clear; the couple could always elect to pay the cost of the nursing home; that is definitely an acceptable expense to spend down with. But they might also consider, if the wife is still driving, trading in her car for a new or newer car. As long as this purchase or trade was made after the husband had already been placed in the nursing home and they/their legal assistance had already set that snapshot where the couple has started to spend down, everything they spend on the new car would come from the husband’s side and be a perfectly legal and viable part of that spend down. Another approved way to spend down is to complete any home improvement that can be done; fixing up the roof, new heating and air, new carpet or furniture—as far as the spend down rules go, it is absolutely okay to replace those things with new ones, and all of those costs would come from the husband’s side of the assets. Our couple should also determine if there is any debt to be paid off; is there a mortgage? Credit card? They can use the husband’s assets to do settle those debts. Have they pre-paid their funeral plans? If this was done before the division of the assets, then it was exempt. If it is done after the husband is placed and the division occurs, the funds would fall under the spend down guidelines. There are all types of things to consider when facing the prospect of spending down money in both a logical and legal way.

Once that money is spent down to the limit dictated by the individual’s state, for example $2,000 in Kansas or < $1,000 in Missouri, the wife is now considered the “community spouse” and she will be entitled to what the law calls a Minimum Monthly Maintenance Needs allowance of at least $1,750 a month. She’ll keep her income—whether that be social security checks, pension, whatever. And if that figure is greater than $1,750, she’ll just get to keep it. If her income is less than the $1,750 mark, she’ll get to keep enough of her husband’s incomes so as to be at the $1,750 per month level. If there’s anything left of his income after that, minus $62 in Kansas and $30 in Missouri and minus the cost of his healthcare, the surplus will be an ongoing copay to the nursing home.

Something else that should be considered—in our example, the countable assets for our couple totaled $100,000. But what if the assets in question amount to $200,000? or $300,000? $500,000? Would the healthy spouse always just get half that figure? Or in other words: What’s the most the community spouse can have?

Currently, the maximum amount that that person could retain would be $109,560—a number mandated by the federal government that changes year to year. So if the couple began with 300,000, it would have to spent down until it would split so that the at-home spouse would get their $109,560, and only at that time would the spend down of the other half of the assets begin. There are many planning steps that can be take in a situation like this one.

The bottom line is to consistently make sure of two things, and every step taken should be rooted in these:
1) Make sure that your loved one gets the care they need.
2) And make sure that as a family, you are never out of money or out of options

In dealing with the care of an Alzheimer’s patient, it is true that there are often things that care-giving loved ones do not expect; there are documents to be drawn up, provisions to be made, and downright unpredictable behaviors from the person they love. But one of the most daunting parts of caring for a loved one with Alzheimer’s can actually be a step that does not come as much of a surprise—finding a nursing home. Indeed, when most people are faced with the idea of caring for a loved one with Alzheimer’s, one of their first thoughts will be about nursing homes; “is a nursing home right for my loved one” or “how will I afford a nursing home” and, most often, “how do I choose the best nursing home?” This post tackles these question and, through the knowledge of a man who has made it his business to know everything there is to know about the process, explains how to find not only the best nursing home, but the right nursing home for your loved one.

Finding that home is no simple task; in Kansas City alone, there are over 25,000 admissions per year into the various levels of care. There are over 300 facilities to choose from, and these facts and figures are something that is overwhelming for most people. Families seeking nursing home care report spending 50-100 hours of their own time in the process of researching and choosing, and even then they are still not always confident in their choices. But the Elder and Disability Law Firm has a different resource; something much more informative and personal than a pamphlet or a website—Steve Kuker. After Steve helped his own grandparents through the transition of home living to an assisted living facility in 2002, he developed a full-service placement program that includes touring care centers with the client and the client’s loved ones and conducting a 47-point inspection and performance audit of the facility. With Steve involved, the only time spent by the families is to have a hands-on tour of the facilities. A few hours spent with a knowledgeable professional are much more valuable than 50-100 hours of grunt work that leaves the family still feeling unsure and unsatisfied. In order to provide an overview of “how to choose the right nursing home,” Steve answered these two questions whose answers get right to the root of choosing care for a loved one with Alzheimer’s or the need for assisted living.

FAQ #1: When’s the right time to transition from home to senior care?
There are a few signs that it is time to look into care, the clearest indicator being that it is no longer safe for the loved one to live at home; if your loved one is leaving burners on, wandering away, committing financial abuse, missing their medication, etc., it is time to consider care.

Another indicator would be when the health of the caregiver begins to decline. Consider a married couple in which the wife cares for her husband, who has Alzheimer’s. She runs herself ragged caring for him, and is now in failing health; it would be at this point that they need to look into professional care.

A third indicator of the need to transition is the financial one. If in-home care is no longer cost-effective, and instead becomes cost prohibitive, it is time to look for placement.

The final indicator comes when the care you’re providing just isn’t enough. This can be a hard indicator to recognize or to accept, as the person who has provided so much care and support in the past. One of the most beneficial ways to view this is to see it as a transition for your loved one, but also for yourself. Why not consider transitioning from care giver to care advocate? In doing so you can take care of yourself, then visit your loved one in their facility as a care advocate instead of the person solely responsible for their well being, and then continuing caring for yourself. It is in this way that everyone is cared for.

FAQ #2: How do we find the right Nursing Home?

First: consider the level of care, both that is available and that your loved one will need.

Second: consider how you are going to pay for that care once you’ve found it? Especially important if you think you/your loved one may outlive your/their assets, it is necessary to look into whether or not the facility you are choosing will later accept Medicaid; which varies by area. In the Kansas City area, it depends entirely on the facility. As a rule of thumb in Kansas City, care will cost five to six thousand dollars a month.

Third: consider the personal needs and preferences of your loved one, such as location (usually very important), or specific hobbies your loved ones enjoy; maybe your mother loves to play the piano, or needs a private room, or adheres to a strict diet, say she keeps Kosher, or is a vegan. These accommodations can be made, and are actual real stories of successful placements.

Steve will then find the top three homes based on those criteria, and then takes the family on a guided tour to present them their best options and give them the final word in the decision process.

When it comes to Medicaid, each state does things a little bit differently. However, every state decides on a maximum number of assets that can be kept in the event that there is a husband and wife, and only one of them needs long term care.

It’s important to note that the rules are much more generous for a husband and wife, compared to a single individual who is applying for Medicaid. The federal government has established a maximum level of assets for husband and wife, the Community Spouse Resource Allowance, or CSRA. This is the amount of money that may be kept so that the healthy spouse can continue to live in the community. Medicaid refers to the spouse who is living at home as the “community spouse.” Please feel free to call our office at (913) 338-5713, and we can tell you what the current maximum CSRA is in our state.

Any assets that exceed the CSRA must be spent down on the ill spouse’s care. From the Medicaid department’s point of view, the ill spouse is referred to as the “institutionalized spouse” or the IS. The IS can have a modest resource allowance as well. That is typically no more than $2,000 in assets (call our office for the exact number). The couple may not have any assets exceeding the CSRA or they will be ineligible for Medicaid. That includes your IRA’s, your cash value life insurance, your CD’s, your brokerage account, your checking account – you are obligated to pay until your resources reach the limit that’s stated here, if those assets are classified as being available for spend down. Make sure you talk to an elder law attorney to see what you must spend down. We have seen many clients who have spent far more money than what was required to spend down at the time of the Medicaid application.

You may remember that previously, you learned that an irrevocable pre-paid burial policy is counted as unavailable. But the rules can be tricky. For example, say you have another life insurance product that you bought years ago, which has a face value (or a death benefit value) of $50,000. This same product has a cash value of $18,000. To the Medicaid department, that looks like $18,000 that you should cash in now to spend on your care. It doesn’t really bother them that your survivor spouse would be much better off getting the $50,000 death benefit at some future time. Nope, if you can get your hands on that cash, regardless of the withdrawal penalty or its future value, the Medicaid department says you need to get it now so you can spend it on long term care. All this has to happen before you will ever become one of those “qualified individuals” who is eligible for long term care with a nursing home benefit paid by Medicaid.

If you’re worried you have too many countable assets and you don’t want to lose your shirt paying for long term care, call (913) 338-5713 to schedule an appointment with one of our attorneys. We can show you your options. Let us show you how our services could benefit you and your loved ones.

Shortly, we’re going to talk about a much nicer subject: the exempt assets. Let’s see what you get to keep when applying for Medicaid!

Many nursing homes have a family council that meets regularly to deal with issues that arise in the nursing home. This can be a great help to loved ones and caregivers – but what if the nursing home in which your loved one resides doesn’t have one? How can you get one started?

Family councils are very beneficial if they are set up and facilitated properly. The goal of the meetings is to talk about issues of the home with the staff in a non-threatening, constructive atmosphere. It is not a place to constantly complain or to degrade the facility or staff. At meetings you can share ideas, concerns, and possible solutions. And you can bond with the staff and develop working relationships with them.

My Alzheimer’s Resource Kit can be a huge help in decision making, facilitating new ideas and programs, and is full of helpful tactics for caregivers – both professional and family caregivers. Please visit my Alzheimer’s Resource Center at AlzheimersResourceKit.com/hammond to get a huge amount of information that will be helpful for you as you work within your family council group. In addition, give my office a call – I’d be happy to talk to any one on your council who has issues with learning about how to pay for care at the home your loved one is at. You may want to ask my staff if I’m available to come speak to your group about some of the legal, ethical strategies you can use to make sure you and your loved one are never out of money or out of options.

If a council doesn’t already exist, talk with the administrator of the facility about your desire to create this council. You will most likely not face much resistance, as these councils are common practice. Decide together how to proceed, where to meet (what room is available), what day and time to meet, who should facilitate the meeting, and how you will inform staff and family members of the meetings. When you have your first meeting, talk with the other families about the best time to meet, and you can decide as a group.

Your meetings can be formal, with minutes, or less formal. The structure isn’t as important as how information is shared.

Another function of the family council is to arrange facility activities that include residents and their families. These activities are usually picnics held at the facility. These functions help encourage the feeling of a family unit for residents, staff, and families.

Frankly, the rules of paying for nursing care can get so complicated it makes your head spin! First let me tell you that many of my clients, about this time, decide they just want to know if I can save them money? If they are likely eligible for benefits?

They want to cut to the chase and find out now what their own personal bottom line is. If that’s you… if you want to know now how you might become eligible and how much you might save, then call my office at (913) 338-5713 and let’s explore whether or not you’re likely to qualify and what you might be able to protect.

You may have assets in lots of different places. You might have insurance policies, checking and savings accounts, IRA’s, 401k’s, CD’s, a car, a boat or RV, an annuity or a home. Let me show you how the Medicaid officials view your money and assets differently. They focus on dividing your financial assets into three different categories:

1. Available Assets

2. Exempt Assets

3. Unavailable Assets

Let’s look a little closer at each of those three types of assets:

Category number one, available assets, is made up of assets that you could cash in and use for your own nursing home care. Available assets are also referred to as “countable resources.” The Medicaid officials view your available assets as the ones you should send every month to the nursing home – at a whopping $5,000 to $8,000 a month.

The second category is referred to as Exempt Assets. The Medicaid Department allows you to keep these assets – even though you may qualify for Medicaid services. If an asset is exempt, you do not have to cash it in to pay for your nursing home bill.

The third category may sound a little bit strange, but it’s called Unavailable Assets. Those are assets which appear to have some value, yet for one reason or another, they are not available to be spent on long term care. One of the best examples of an unavailable asset is an irrevocable prepaid burial insurance policy. Prepaid burial insurance policies are a relatively straightforward insurance product in which a person spends money now for the future promise to pay for burial cost. Typically the burial insurance product is put together so that it is irrevocable and non-assignable (that just means that once it’s done, you can’t change it). It’s only available for one purpose – to pay a funeral home for your final expenses. After all, even Medicaid department doesn’t want to deal with all these buried bodies… so they’ve been generous enough to allow you to pre-pay for your funeral. Even if you paid $12,500 for that particular policy, it’s just plain unavailable to you for nursing home care.

If you’d like to learn more about how the Medicaid department views your money, give us a call at (913) 338-5713. Our experienced team of attorneys can show you how Medicaid “sees” your assets. Transform some of your “available” life savings into exempt or unavailable assets.

Many caregivers find it very difficult to visit their loved one in a care center. If that’s you, you may find you don’t know what to say or what to do. This causes some caregivers to avoid going to see their loved ones at all, which then makes them feel terribly guilty. Is there a way to make visits easier?

Yes! In fact, there are lots of ways to make visits more pleasant. Caregiving Absolute #7 tells us: ”Never Say “You can’t,” instead show what they can do – and your loved one may be able to do a lot!

First, don’t be so hard on yourself for the times you haven’t gone to see your loved one. You must recognize that you are suffering the loss of the role your loved one has played in your life. They can’t be the person they once were, the “one in charge” any longer, but they can be your beloved friend with whom you can share favorite things, smiles, hugs, laughter, and even tears.

Go on your visits intent on sharing something: bring their favorite ice cream, a magazine with pictures of things they like, a bouquet of wildflowers, a family photo album, a CD of music you both might enjoy, or anything else you can look at or do together. When you arrive, greet your loved one warmly, hug, and say something like “I am so happy to see you! Look what I brought.” Then spend time sharing your treat or looking at what you brought.

Make comments about it rather than asking questions, and watch and listen for her to show interest, react, or smile. You don’t have to stay long if you find it too difficult, but if you plan what you are going to do that day, you will see your visits improve and will find it easier to go. Your loved one will also be able to read your body language, so if you are smiling, hugging and joking, it will put you both at ease. That’s something we can all use a little more of.

How do you get the best care for your loved one at a facility? This is a question many caregivers pose to themselves. This tip will be addressed to both the family members of those with Alzheimer’s, and the staff at the care facility.

First to the families: When you first admit your loved one to a nursing home, get to know the staff. Express to the staff that you care about their well-being and that you would like an open relationship to discuss issues concerning your mother’s care. Let them know pertinent information about your loved one and her life—her likes, dislikes, rituals, moods, and how to approach her in different situations. The more they know about your loved one, her background and personality, the better they can care for her. Compliment the staff when you see them doing something you like. Be involved with the facility as much as possible. Attend social events and family council meetings if they are available. And bringing little treats like donuts and chocolates never hurt!

One man took a picture of his wife and the staff on her unit. He had the picture blown up to an 8 x 10 and put the name of each caregiver underneath their picture. He then placed the picture on her closet door. This serves two purposes, to help his wife recognize the people in the picture and to help the staff feel included. It made the staff feel important and that the family really cares about them. This small gesture bridged a lot of gaps.

To the staff: Don’t be intimidated by the families of the residents. Without you, there would be no care for their loved one. You are the front line worker. They have entrusted the care of their loved one into your hands. That is quite a compliment and an honor. Show an interest not only with the resident but also the family. Introduce yourself and tell them a little about you, your life, your interests. You may want to let them know how long you have been a caregiver and why you chose this line of work. When the family enters the unit, greet them and give them information concerning their loved one, both good and bad. If their loved one does something good during the day, call them and let them know. These are the little blessings.

Unfortunately, there is still a stigma concerning nursing home care and the people who work there. Everyone needs to work together to overcome these negatives so the residents will have a positive experience in their new home.

Many caregivers want to know, when their loved one must move to an assisted living facility or nursing home, how they can help their loved one make that transition as safely and easily as possible. There really is so much you can do to assist your loved one with this transition… but the best thing is having a caring, involved advocate like you to make the transition as smooth as possible.

First, don’t try to assume how your loved one is feeling or remind him of all the reasons he should make the transition. What he needs to know most of all is that his relationship with you will not change regardless of where he lives.

You may want to purchase a pull-out couch or chair for your loved one’s new place, so you can stay there with him sometimes. If he‘s moving closer to you, focus on how much more often you will get to see him… then make certain that you do see him more often.

If it is early enough in the disease process that he is making the decision to move himself, then he probably just needs muscle to help him sort and organize things, deliver items to family members or donate. You’ll also want to talk about what items from his old place you should keep at your home for safe keeping or to pass on through the family. You may want to offer to get the garage sale signs, set up for the sale and man the day of the sale.

If things are at the stage where he is not making the decision and changes his mind (or doesn’t even remember that he agreed to the decision) then don’t argue and don’t try to reason with him. In fact, you will do well to avoid the subject entirely, just make certain you spend as much time with him as possible and focus on the things you have always enjoyed doing together.

When all else fails, go and get ice cream. (Even if you are watching your weight or diabetic, you could have a small portion or look for sugar free alternatives.) Make sure you touch and hold your loved one… show your love and caring. If you hug, hug more, if you hold hands, do it more often. Tell him stories about all the wonderful things you have done together and tell him how much you love him and appreciate all he has done for you. These simple things can help any transition.