The Caring Resource

Veterans and Veterans Benefits

We have all heard the statistics.  Americans are living longer, and because of it are requiring more healthcare services.  For those in the 65+ age group, which is currently the fastest growing segment of the American population, home healthcare services are in the greatest demand. With the home healthcare industry barely able to keep pace, it is expected that home healthcare costs will skyrocket.  Who can afford to pay such costs?  Not many!  Unless a person has a long term care insurance policy, it is a well known fact that Medicare and Medicaid are not going to provide much assistance. Are we missing something?  Is there another way to pay? The answer is, “yes”, and it relates to veterans and veteran’s benefits.   

If they qualify, a veteran and/or his or her surviving spouse will be entitled to receive a monthly pension benefit, which is more commonly referred to as the “Aid and Attendance Benefit”.  The Aid and Attendance benefit is designed to pay for home healthcare services.  For 2008, the maximum monthly benefit to a veteran is $1,554, married veteran is $1,842, and surviving spouse of a veteran is $998.  So do all veterans and or his or her spouse, who are 65 years of age or older, and need home healthcare services, qualify for the Aid and Attendance benefit? The answer is, “no”, but simple planning strategies, the majority can qualify for the benefit.  To qualify, the veteran and/or his or her spouse must pass three tests, including a: (1) military service test, (2) healthcare necessities test, and (3) an asset and income test.

To pass the military services test, the veteran must have served at least 90 consecutive days of active duty, and one of the days occurring during a war-time period (WWI, WWII, and Korean War, Vietnam War), and received an honorable discharge. To pass the healthcare necessities test, the veteran and/or his or her surviving spouse must be able to prove that he or she is unable to dress or undress, attend to the wants of nature, and as a result of the physical or mental incapacity requires assistance on a regular basis in the home.  In support of conditions, it is necessary to obtain a physician’s statement which substantiates the conditions, and specifies that there is a need for regular assistance to avoid daily environmental hazards.  If the person is blind, and/or unable to drive, it is, without question, that the person will require daily assistance. Finally, to pass the asset and income test, the veteran and/or his or her surviving spouse must show that, excluding the value of the family home, the household furnishings, and one motor vehicle, their total assets are valued at $80,000, or less, and their monthly income is less than their unreimbursed medical expenses.  Unreimbursed medical expenses, in a home healthcare setting include: the cost of home healthcare aides, doctor’s fees, dentist’s fees, prescription glasses, hearing aids, Medicare premiums, medical transportation costs, prescription drugs, and therapies.

The VA statistics currently show more than 23,816,000 veterans, of which 39.1% are 65 years of age or older. Are many veterans and/or his or she surviving spouses taking advantage of the Aid and Attendance Benefit Program?  With the VA statistics also showing that only 317,439 veterans and/or their spouses are currently receiving on the program, the answer is, “no”.  So where does the problem lie?  The problem lies in the fact that most veterans are not aware of the Aid and Attendance Benefit Program.

However, with more and more seniors now using computers and researching on the web, along with attorneys now certified to work with veterans, the statistics are starting to change.

How do you find out about this benefit?  How do you qualify?  Are you or is your client a candidate?  Is there in-home support?

As there is much information available online today regarding this benefit and the associated steps you must make to qualify, there is important consideration for an applicant’s situation as a whole.  Do you/they currently have in-home care?  Does the applicant meet the ADL minimum requirements?  Is there a financial plan in place?  Is the potential applicant working with an estate planning or elder law attorney? Does the overall plan blend well with possible Medicaid benefits?

It is important to understand the processing time involved with a VA A& A application, the consequences of an in complete or denied application.  We invite you to post your questions and/or comments on this blog or email Dale M. Krause directly at [email protected].

About the author, Guest Blogger:

Dale M. Krause, J.D., LL.M.
For more than 20 years, Dale M. Krause, J.D., LL.M., has provided Medicaid Compliant Annuities to elder law attorneys, and their clients, throughout the United States.  As a result of his practice, Mr. Krause has been labeled "The Pioneer of Medicaid Compliant Annuities."
 
Mr. Krause is the CEO of Krause Financial Services, a business that designs, develops, markets, and distributes Medicaid compliant products.  Mr. Krause earned his B.S. degree from the University of Wisconsin-Stevens Point, in 1981, his J.D. degree from Thomas Cooley Law School, of Lansing, Michigan, in 1985, and his LL.M. in Taxation from DePaul College of Law, of Chicago, Illinois, in 1990.  He is a practicing member of the Wisconsin and Michigan Bars, and is an out-of-state member of the New York Bar Association.  He is a licensed insurance agent, and is registered to sell stocks, bonds, and mutual funds.

Serena Brock

Interesting Statistics

According to AARP, 59 percent of people older than 65 are living on a fixed income.

Roughly 7 out of 10 people living with Alzheimer's disease are living at home and receiving 75% of their care from informal care partners.

DID YOU KNOW?

Aging seniors and the disabled have a right, spelled out in the U.S. Supreme Court's Olmstead decision of 1999, to enjoy care services in the least-restrictive environment possible. Oftentimes, that means at home rather than in a nursing home.

Retirement is not etched in stone...

Well, with all of what is going on in our country today...most of us have first hand experience of how quickly our "plans" for retirement can change. In fact, it is just like any other part of our lives, change happens when you least expect it.

One thing that we do know, is that based on numerous studies, it is those people who will and are experiencing the most enjoyable retirements are the ones who have planned appropriately for them.

Although our country is in an economic down turn and many have lost their savings as a result of the stock market plunge, there is no time better than now to protect those assets that you worked so hard to earn.

Planning for your future is much more than just financial considerations. It includes protecting your assets from family changes such as divorce, second marriages, children who are incapable of managing money and considering how you will carry out your years physically, emotionally and geographically.

Who and how you will be cared for in the event of a health crisis. Do you want your spouse to care for you at home? What about when you are unable to perform the activities of daily living such as bathing, toileting and dressing? Do you want your spouse, children or other family members to assist you? Would you prefer that your dignity is not compromised and allow a professional caregiver to help? I know that it is not a conversation that is welcomed, but it is ever so important to address these issues before a crisis hits.

Will you remain at home? Move in with your adult children? Assisted living center? Long term care? How your surviving family will carry on after you are gone.

Now, I am not an attorney but I have had the pleasure of working with and learning how invaluable an estate planning attorney or one who specializes in elder law is. In fact, over the past several years, I have become a huge advocate of the importance of engaging in their services.

So I urge you - learn more about the importance of protection such as wills,healthcare directives, guardianships, trusts (including special needs trusts), estate planning and Medicaid planning. Isn't it worth it to learn how you can protect yourself, your family and everything you have worked so hard for?

Serena L. Brock

Social Security

According to the AARP, 3.1 million Americans depend on social security as their main source of income.

Long-term care protest planned -- 'What's happening is wrong'

 

Posted By CAROL MULLIGAN, THE SUDBURY STAR

 

A Sudbury woman with 27 years in the long-term care sector says workers in the system are so stressed, the rates of violence and abuse in nursing homes are "astronomical."

Staff charged with caring for 10 to 16 adults in a single shift are cutting corners and "care is not getting done," said Anne Marie MacInnis at a news conference Tuesday.

MacInnis is a Sudbury representative on the Ontario Health Coalition and an organizer of the All Out Mass Protest scheduled in several Ontario cities, including Sudbury, on Saturday.

The Sudbury rally is being sponsored by the coalition and the Sudbury and District Labour Council.

MacInnis, who is an organizer for Mine Mill Local 598/CAW, said the rallies are targeted at Premier Dalton McGuinty, and will call on him to keep his election promises to support public health care.

"Alarming rates" of violence, injury, accidents and neglect are occurring in long-term care homes where employees don't have the time to care for the number of residents they are responsible for every day.

Organizers are calling on the McGuinty government to stop the cuts to hospital services, stop funding private-public partnerships in health care, end competitive bidding in home care and regulate a minimum standard of care in long-term care residences.

A core group of employees in the home care, long-term care and hospital sectors will participate in the rallies.

Sudbury's All Out Mass Protest is scheduled from 11 a. m.-3 p. m. at Tom Davies Square.

Starting at 8 a. m., workers will present street theatre presentations to "engage" the public in the discussion, said MacInnis.

Thousands of people are expected to participate in rallies in Toronto, Windsor, Kingston, Thunder Bay and Sudbury.

"What's happening is wrong," said MacInnis, and the purpose of the All Out Mass Protests is to "tap into social awareness" about that.

John Closs, president of the Sudbury and District Labour Council, stressed the protest is not a labour event although OPSEU, CUPE, Mine Mill/CAW and Steelworkers members will participate.

These issues "affect everybody," said Closs.

 

Serena L. Brock

Home Care Today– Growing Options and Risks

as published in:     Simply the Best  Barbara McKay Magazine   Spring/Summer 2008

Home Care Today– Growing Options and Risks

With an estimated 4.2 million Americans currently over age 85, an expected 78 million baby boomers to reach age 65 by 2030;  almost 25% of Americans are in the process of dealing with elder/care issues, it is no surprise that the home care industry is exploding.

Growing Options

It's not easy to become elderly or a parent to your parent(s). The “Sandwich Generation”, those sandwiched between aging parents and their own children, face a number of key areas critical to elder care;  aging, legal, medical,  financial and living arrangement issues. Support from an in home caregiver can help to assist with the activities of daily living, while providing companionship, whether it is your own child, spouse, sibling or an aging parent.

The type of home care service needed depends on several factors:  mental/ physical health condition, support from family or friends, residential location, availability of finances.  Financing may be long term care policies, money from a trust, state funded programs, insurance, Veterans aid and attendance benefit or private pay. Licensed home care agencies provide qualified caregivers such as companions, certified nursing assistants, nurses and rehabilitation therapists. Their services cover: activities of daily living, nursing/wound care; rehabilitation, case management, pre/post operative care, errands, etc.  In addition to elder care, services can include pre/post operative care, new moms and multiples support, short term disability and illness.  For employers, some agencies offer packages to help save on lost time/revenue as a result of employees forced to miss work to care for sick parents and/or their own children. Imagine the comfort and peace of mind knowing your loved one is in good hands whether you live near, with or far from your loved one.

Risks

With many home care agencies choices, all making the same promises, it is critical to carefully select your agency.  Unfortunately, not all are honest and ethical. We recommend you ask to see the agency’s policy on orientation, screening, testing and supervision. The National Association for Home Care and Hospice, NAHC, is a great resource in each state.

A Question of Quality and Ethics

Home care is a very personal choice and can be an invaluable service.  Too often, we are witness to heart wrenching cases where neglect, abuse, theft and lawsuits have occurred as a result of families trying to save money by privately hiring their own caregivers. Like any other service, you pay for what you receive. In addition, if someone is offering to buy items to gain or keep your business, question their ethics. Peace of mind is worth the price. Call and interview agencies. Ask for references.  Take your time and be sure that you feel a connection with them. Visit their office.  Trust and confidence in your agency, its internal staff and its caregivers is critical. Make informed decisions based on your own research. After all, they spend a great deal of time in the home, and truly become an extension of your family!

Leading Education & Ethics in Charlotte and Across the Country

Serena Brock -  nationally recognized entrepreneur/speaker and focuses on the importance of the synergistic relationship between attorney’s, financial planner’s and home care owner’s supporting the fast growing baby boomer population.   An advocate for children/seniors, she currently is a member of the North Carolina Association for Home and Hospice Government Affairs Committee, the North Carolina Guardian ad Litem Foundation and the World Orphans Day, Global Click Campaign. Brock lends her expertise to several national organizations including the National Private Duty Home Care Association, Medicaid Practice Systems, Elder Law Answers and The National Network for Estate Planning Attorneys.

13% of Seniors Report Being Mistreated

THURSDAY, Aug. 28 (HealthDay News) -- A new study says that 13 percent of American seniors suffer mistreatment from various forms of abuse.

 

The University of Chicago researchers said the chief forms were verbal abuse

(9 percent), being taken advantage of financially (3.5 percent), and physical abuse (0.2 percent). The team also found that seniors with physical impairments were most likely to suffer verbal abuse.

 

"Older people with any physical vulnerability are about 13 percent more likely than those without one to report verbal mistreatment, but are not more likely to report financial mistreatment," study co-author Linda Waite, a professor of sociology, said in a university news release.

 

The analysis of national survey data from 3,005 community-dwelling adults, ages 57 to 85, also found that adults in their late 50s and 60s are more likely to report verbal or financial mistreatment than those who are older.

 

"Perhaps the respondents are including fairly routine arguments, perhaps about money, with their spouse, sibling or child in their reports, or perhaps older adults are more reticent to report negative behavior," lead author Edward Laumann, a professor of sociology, said in the news release.

 

Women were twice as likely as men to report verbal abuse; Hispanics were about half as likely as whites to report verbal abuse and 78 percent less likely to report financial mistreatment; and blacks were 77 percent more likely than whites to report financial mistreatment.

 

Of those who reported verbal abuse, 26 percent said their spouse or romantic partner was responsible, 15 percent said it was their children, and the remainder of respondents said friends, neighbors, co-workers or bosses were responsible. Of the respondents who reported financial abuse, 57 percent said a relative other than a spouse, parent or child was taking advantage of them.

 

The study was published in the Journal of Gerontology: Social Sciences.

 

"The population of this country is aging, and people now live with chronic diseases longer. So, it's important to understand, from a health perspective, how people are being treated as they age," Laumann said.

 

Serena L. Brock

Senate Bill Seeks to Expand Medicaid Coverage of Home and Community-based Care

Prior to leaving for the August Congressional recess, Senators John Kerry (D-MA) and Charles Grassley (R-IA) introduced the “Empowered at Home Act” (S. 3327 <http://thomas.loc.gov/cgi-bin/bdquery/z?d110:s.03327:> <blocked::http://thomas.loc.gov/cgi-bin/bdquery/z?d110:s.03327:>  ), a bill that seeks to increase access to home and community based services by giving states new tools and incentives to make these services more available to those in need.

In a statement upon introduction of the bill, Kerry said, “Far too many elderly or disabled Americans can’t get the help they need in their home and community. Home- and community-based services are high-quality, cost-effective, and help many people live independent lives, but Medicaid continues to favor nursing homes. It’s a problem when the nation’s largest purchaser of long-term care services is tilted towards nursing homes rather than home and community based services. This bill will level the playing field and give families real choices to care for their loved ones, and give cash-strapped states new tools to provide cost-effective long-term care options to the most vulnerable.”

“Being able to live at home greatly improves quality of life because people can be with loved ones and have the dignity that goes with greater independence,” said Grassley. “This bill encourages states to help make that possible, which is also fiscally smart because institutional care is the most expensive form of long-term care that Medicaid pays for. This bill also empowers individuals to manage the financial burdens that come with caregiving needs.”

The bill has four basic parts:

1.      It seeks to improve the Medicaid Home and Community-based Services (HCBS) State Plan Amendment Option by giving states more flexibility in determining eligibility for which services they can offer under the program, creating greater options for individuals in need of home and community-based services, and providing some additional funding to assist states in making the transition. It would establish parity in income eligibility standards for home and community based services and institutional care at 300 percent of the Supplemental Security Income (SSI) level ($22,932/year). In return states could no longer cap enrollment and would have to offer services throughout the entire state.
2.      It would require that the same spousal impoverishment protections offered for new nursing home beneficiaries be in place for those opting for home and community based services. In addition, low-income recipients of home and community based services would be able to keep more of their assets when they become eligible for Medicaid, allowing them to stay in their community longer.
3.      It would offer tax-related provisions to support family caregivers and promote the purchase of private long-term care insurance.
4.      It would provide grants for states to invest in organizations and systems to help ensure a sufficient supply of high quality workers, promote health, and transform home and community based care to be more consumer-centered.
Section 201 of the bill would provide grants that states could use to create one or more statewide or regional public entities or non-profit organizations to address workforce issues, including training, screening, and taking on many of the responsibilities of the employer of home care workers. Although the legislation does recognize “the multiple delivery options that take into account differing needs of individuals” and ensures that consumers would not be restricted to hiring workers from such entities, the creation of these entities (sometimes referred to as public authorities) would be a cause for concern by many home and community-based providers and consumers. Such public authorities can result in discouraging home care aides from working for home care agencies or consumers from obtaining home care aides services through agencies. In its Legislative Blueprint for Action, the National Association for Home Care & Hospice (NAHC) maintains that consumers should have the right to choose to receive home care aide services according to the delivery model that they are most comfortable with. In addition, home care aides should have the opportunity to choose their employer. Home care agencies are better equipped than public authorities to provide worker training, screening, and oversight.

Serena L. Brock

The Power of Gratitude

Caregivers -- Ask your loved one, "What are you thankful for today?"  It may be the gift of love, how blessed the person feels to have someone who cares for him, or that he's in his own home.  If the person's in a facility, maybe it's the lady who comes by to give her a little smile or stroke on the cheek.

And when you write it down, what a great thing.  So get a dry-erase board, put it within eyesight fo the person and write "Today's Thank You" across the Top.  Maybe it's just one thing: "Tell me something that good today.  Oh, it's beautiful outside.  Let me turn you so that you can see the gorgeous sun!"  Then write, "Today's  a beautiful sunny day." Add the date, and maybe a pretty picture.

Before you change it, write it in a notebook.  Then when your loved one is having a particularly blue day, you can say, "You know, I know today's not a good day, but remember last week when the Girl Scouts came and sang..." Revisiting a positive memory may make a day that isn't such a great day, a better one!

Serena  L. Brock