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Saturday, December 17, 2011

There Go The Social Safety Nets (to help pay for catastrophic long-term care!!)

 

by Susan M. Graham, Attorney at Law, Senior Edge Legal, Boise, Idaho

We have no money in this country.  We all know that.  How does this impact on you if you need to pay for residential long-term care in a nursing home, assisted living or in your own home?

There are two government programs that are available to seniors to help pay for care - Medicare and Medicaid.

Medicare is a national health insurance program for people 65 and older.  Medicare will help pay for a maximum of 100 days of care.  To access this benefit a few requirements must be met.  First, a person must be admitted to a hospital and stay there at least three days.  Then, when they are discharged to a rehabilitative facility, such as the Boise Elks, if that person is improving, Medicare will pay 100% for the first 20 days of care.  If the person continues to improve, Medicare will pay part and the individual or their supplemental insurance will pay part of the expense for the next 80 days.

What are the holes in this "safety net"?  First, the Medicare recipient must be ADMITTED to the hospital and not there for OBSERVATION.  The difference is huge.  If a person is not admitted, Medicare will not pay a dime toward the rehabilitative care.  If Medicare does not pay, then in most cases the supplemental health insurance coverage will not pay for the care as well.  This problem is happening here in Idaho as well as nationwide.  The bills for the first 20 days that I've seen range from $6,000 to $30,000.  This is a huge bill for most individuals and families to absorb.

The next hole in the Medicare safety net requires that the person be "Improving" during their rehabilitative care.  My cousin, Kathie, at age 98, went to the hospital for three days.  She was admitted.  They discharged her back to her nursing home and I was called two days later saying Medicare would not pay for her care because she was not "improving."  She was old and could not follow instructions.  I was not surprised that she failed this second test.

Another "safety net" is the federal and state Medicaid program.  Part of this program helps to pay the long-term residential care expenses for people 65 and older who meet a list of criteria.  The cost for privately paying these bills ranges from $20 per hour for a bath aide to $8,000 per month for skilled nursing care.  To access this benefit, it is necessary to complete an application form and submit it to the Idaho Department of Health and Welfare.  The last two application forms we submitted on behalf of a married couple were approximately 400 pages each.

There were at least six more inches of back-up information.  It took hours and hours to sort out and complete the application and deal with the follow-up issues.  All of our Medicaid applications have been approved in the past 5 years, but remember I have a law office.  The process is onerous and next to impossible for regular families in crisis to complete on their own.  That is not fair, but it is the real world.

We have no money in this country to continue to provide the safety nets that have been available.

What can you do to protect yourself and your loved ones?

  1. Make certain you have up-to-date legal documents that include your Living Will, Health Power of Attorney and Financial Power of Attorney.
  2. Let the people you plan to rely upon in a crisis know you have nominated them to help.
  3. If you need help, seek it out.  Your failure to make informed decisions may cost you and your family thousands of dollars and unnecessary worry.
  4. Contact your government representatives and let them know you want honest safety nets that really work, not ones that exist on paper and are not really accessible to regular people.

 





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