The worst long-term care decisions

When it comes to illness, an old saying comes to mind “Denial is not a river in Egypt.” All kidding aside, chronic illness is a scary thing and, as people age, thoughts of it can take center stage. There are ways of thinking that can block rational decision making and here are some of them and some information to make an informed decision.

• I will not get sick, but if I do my family can take care of

me. With the notion that everyone or almost everyone wants to receive care at home, you might think that at home services are easier and readily available even at government expense. True, people often do stay at home for long periods even after they are ill. Parents share homes with adult children. Spouses may have husbands or wives physically and mentally able to care for them. Hospice care which is covered by Medicare insurance can help. But longer term chronic conditions can exhaust families and the level of care needed may be beyond the abilities of adult children or spouses who might also be sick. There is limited government help at home in Pennsylvania and that is mostly for those with very limited resources and limited income.

• I have long-term care insurance. That takes care of everything. When I ask people who have long-term care insurance the length of their elimination period, their daily benefit, the maximum payout, and whether the elimination period depends on calendar days or days of service, they generally do not know. We have had clients on Medicaid who also are receiving long-term care insurance. It can depend on how much and the terms of the policy. What this means is, if you do have long term care insurance you should have its terms reviewed periodically by someone who knows. Elder law attorneys often perform this kind of service.

• Help will come into my house. It will be less expensive. Maybe. Whether at-home care is more or less expensive than nursing care depends on how much care you need. 24/7 care at home will likely cost more than a nursing home. Make sure you deal with a reputable home health care agency.

• Medicaid will never apply to me. The idea that “I will only think about Medicaid if I am broke” is a

mistake. When you are broke it often is too late to plan effectively. Planning needs to come in advance. This is even if you never expect to use any sophisticated techniques. If you gave money to your son or daughter during the past five years when they were out of work or needed help, you could be penalized later. If you do not plan for your burial expenses in advance with an irrevocable burial reserve, your family could be paying for a funeral with their own funds unnecessarily. There are special rules for spouses to protect them

even during the five-year look-back period. You need to know what bills you should pay and when.

• Nursing homes that take Medicaid are inferior

or government run. Some of the best facilities in the area are Medicaid certified. Pocopson Home, the Chester County facility, has an excellent reputation. Each facility has to be considered on its own but there is nothing about a Medicaid certified facility that makes it less qualified to care for residents. Several retirement communities that require large up front payments are now

also Medicaid certified. • I can stay in assisted living/personal care indefinitely no matter what my

condition. Personal care facilities are limited by law. There are levels of care. • If I find myself getting sick, I should transfer everything I have to my children and wait five years because of the “lookback”

rules. Since the Deficit Reduction Act went into effect on February 8, 2006 establishing a five year “lookback,” there has been even more misunderstanding about gifting than there had been before. For the vast majority of potential

patients, the “transfer everything to the children” idea is a terrible idea. Also planning can be done in some cases even during the lookback period. I ask clients do they really want to ask their children for money. Rules for spouses and disabled children can help. The rules are complicated and you should seek professional advice if needed.

Janet Colliton, Esq. is a Certified Elder Law Attorney and limits her practice to elder law, retirement and estate planning, Medicaid,

Medicare, life care and special needs at 790 East Market St., Suite 250, West Chester, Pa., 19382, 610-436-6674, colliton@ collitonlaw.com. She is a member of the National Academy of Elder Law Attorneys and, with Jeffrey Jones, CSA, cofounder of Life Transition Services LLC, a service for families with longterm care needs. Tune in on Wednesdays at 4 p.m. to radio WCHE 1520, “50+ Planning Ahead,” with Janet Colliton, Colliton Elder Law Associates, and Phil McFadden, Home Instead Senior Care.