The Hughes Law Firm

Many of the children of our older clients are exhausted with their caregiving chores.  Limited sleep, juggling time with their own families, traveling from one house to another…it’s overwhelming.  There’s help, however, if they know where to look.  Here’s one very valuable resource.

Families–not social service agencies, nursing homes, or government programs–provide the majority of long-term care (LTC) for older persons in the

These caregivers include spouses, adult children and other relatives and friends.  The degree of caregiver involvement has remained fairly constant for more than a decade, bearing witness to the remarkable resilience of the American family in taking care of its own.  This is despite increased geographic separation, greater numbers of women in the workforce and other changes in family life.  Thus, family caregiving has been a blessing in many respects.  It has been a budgetsaver to governments faced with the challenge of covering the health and long-term care expenses of persons who are ill and have chronic disabilities.  The economic value of our nation’s family and informal caregivers has been estimated at $257 billion annually.

The enactment of the Older Americans Act Amendments of 2000 established an important new program called the National Family Caregiver Support Program (NFCSP).  The program calls for all states, working in partnership with area agencies on aging and local community-service providers, to have five basic services for family caregivers.

These services include:

●  Information to caregivers about available services;

●  Assistance to caregivers in gaining access to services;

●  Individual counseling, organization of support groups, and training to assist the caregivers in  

    making decisions and solving problems relating to their caregiving roles;

●  Respite care to enable caregivers to be temporarily relieved from their caregiving responsibilities;

    and

●  Supplemental services, on a limited basis, to complement the care provided by caregivers.

Currently funded at $155,200,000, this program has served more than 275,000 caregivers nationwide.  Efforts regarding NFCSP have resulted in new partnerships, improved access to services, outreach to special populations, and the provision of services to respond to the unique needs of families.

Eligible Populations

●  Family caregivers of older adults and

●  Grandparents and relative caregivers, age 60 years or older, of children no older than age 18

    (including grandparents who are sole caregivers of grandchildren and those individuals who are

     affected by mental retardation or who have developmental disabilities)

Who to Contact for Help

Older persons and caregivers can call the Eldercare Locator toll-free at 1-800-677-1116 or visit www.eldercare.gov.

Filed under: Medicaid, Trusts by Richard Hughes
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Over the years I’ve discovered that most people are confused about how much Medicare (not Medicaid) will pay for nursing homes expenses.   This post from Elder Law Answers should clear this up.

Many people believe that Medicare covers nursing home stays. In fact Medicare’s coverage of nursing home care is quite limited.

Medicare covers up to 100 days of “skilled nursing care” per illness, but there are a number of requirements that must be met before the nursing home stay will be covered. The result of these requirements is that Medicare recipients are often discharged from a nursing home before they are ready.

In order for a nursing home stay to be covered by Medicare, you must enter a Medicare-approved “skilled nursing facility” or nursing home within 30 days of a hospital stay that lasted at least three days. The care in the nursing home must be for the same condition as the hospital stay.

In addition, you must need “skilled care.” This means a physician must order the treatment and the treatment must be provided daily by a registered nurse, physical therapist, or licensed practical nurse.

Finally, Medicare only covers “acute” care as opposed to custodial care. This means it covers care only for people who are likely to recover from their conditions, not care for people who need ongoing help with performing everyday activities, such as bathing or dressing.

Note that if you need skilled nursing care to maintain your status (or to slow deterioration), then the care should be provided and is covered by Medicare. In addition, patients often receive an array of treatments that don’t need to be carried out by a skilled nurse but which may, in combination, require skilled supervision. For example, the potential for adverse interactions among multiple treatments may require that a skilled nurse monitor the patient’s care and status. In such cases, Medicare should continue to provide coverage.

Once you are in a facility, Medicare will cover the cost of a semi-private room, meals, skilled nursing and rehabilitative services, and medically necessary supplies. Medicare covers 100 % of the costs for the first 20 days. Beginning on day 21 of the nursing home stay, there is a significant co-payment ($128 a day in 2008). This co-payment may be covered by a supplemental Medicare policy.  After 100 days are up, you are responsible for all costs.

If you are in a nursing home and the nursing home believes that Medicare will no longer cover you, it must give you a written notice of non-coverage. The nursing home cannot discharge you until the day after the notice is given.  The notice should explain how to file an expedited appeal to a Quality Improvement Organization (QIO). A QIO is a group

of doctors and other professionals who monitor the quality of care delivered to Medicare beneficiaries. You should appeal right away. You will not be charged while waiting for the decision, but if the QIO denies coverage, you will be responsible for the cost. If the QIO denies coverage, you can appeal the decision to an Administrative Law Judge (ALJ). 

If you have questions that aren’t answered here, feel free to call (303) 4-ADVICE (423-8423) and we’ll try to help.

Filed under: Medicaid, Trusts by Richard Hughes
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I did something this weekend that I never thought I would do.  I started the Nutrisystem™ weight-loss program.

Over the past couple of years, I’ve watched my midsection grow as my age increased.  Where I used to be able to see my belt buckle when I looked down, I now have to stick my neck out.  Those slacks with elastic on the sides have become my favorite garments.  The buttons on my sport coats no longer match up with the button holes without sucking up.

Even though I was getting concerned about the extra 15 pounds I was carrying around, I couldn’t seem to figure out exactly how to deal with the problem.  I started persuading myself into thinking that I was eating less or more healthy, but I would find myself dropping right back into the same old routine and over eat at almost every meal.

I even bought a juicer and started buying mega quantities of vegetables at King Soopers instead of potato chips, Oreos and ice cream.  While my juicer served a worthwhile purpose (making me feel better about myself), it started to get old after awhile.  I turned back to my old habits.

I could go on and on with all of the same excuses that you’ve heard before, but to spare everybody, I will simply cut to the solution:  A system.

I have been studying under a life coach for over 3 ½ years and have been learning the secrets to making my practice more efficient, predictable and easier to run.  My coach has emphasized the use of systems so that you don’t have to do anything new more than once.  Systems are designed to produce quality as well as economy.  In short, with systems, we can do things more efficiently and do them all much more accurately.

Unfortunately, I was missing the point regarding my health and weight management.  I couldn’t seem to extrapolute this idea of systems between the two concepts of business and self.  Then I ran into an acquaintance about three weeks ago who just started the Nutrisystem™ program and was feeling pretty good about himself.  I quizzed him for five or ten minutes because I had been watching the Nutrisystem™  commercials on TV and was getting interested.  My friend’s testimonial about the positive effects pushed me over the edge.  I went on online, contacted Nutrisystem™ and started digging around.  I didn’t buy on the first exploration.  Two days later, however, a sales person from Nutrisystem™ called me up and offered a “special discount” and a couple weeks of free food if I would make a decision to buy on the spot.  I guess I was ready, so I said “yes.”

I got this huge box of food in the mail last Friday, read all of the enclosed literature and found myself eating my first Nutrisystem™  breakfast on Saturday morning.  My daughters laughed at me and predicted that I would fall off the wagon within a few days.  I told them that I was committed and I was going for it.  My goal is to lose 15 pounds in however much time it will take.

It’s now been five days and I feel pretty darn good.  I don’t feel bloated, fat or hungry.  The portions I have been eating have been surprisingly small, but I’m satisfied.  Two hours after I am done eating, I am required to eat again.  And then two hours after that I eat again.  In other words, every two to three hours I am eating something that keeps my metabolism up and my hunger at a low ebb.

The key question now is whether I will stick with the program.  The bottom line is that I now have a system to follow that gives me comfort and predictability. 

As I relate this process to my estate planning practice, I see what Nutrisystem™ does is nothing different than what I do for my clients.  I give my clients a system for planning that gives them the comfort of knowing that their desired results for their family will be achieved many years down the road.  The Trust, the Powers of Attorney, HIPAAs, Living Wills, our Inner Circle up-dating program…they all work together as a coordinated plan and form the system that creates peace of mind.  There’s no guess work or uncertainties.  While there is a commitment up front and a continuing commitment to stay up-to-date over time, the system is in place to make sure that everything happens correctly when it’s supposed to.

Many folks come to see me who are unsure of what they really want to do at the initial consultation.  When they make the decision to go forward, I believe–now looking at the Nutrisystem™ program–they make that decision because they see and appreciate the system behind what I do.  And my guess is that my clients didn’t think they would become clients right away until they saw how the system would solve their problems and make their concerns evaporate.  Weight control, estate planning, technology, or exercise; they’re all the same thing.  Trust the system. 

Filed under: Medicaid, Trusts by Richard Hughes
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Yesterday I had a little spare time, so I decided to surf the net to see what was out there about estate planning…and man, did I find plenty.  Most of what I found were websites that promised a flawless estate plan—complete with a living trust—for under a hundred bucks.  They all claimed how easy it was to “do-it-yourself” and avoid the expense of an attorney.  Some even promised you could do it all in less than 30 minutes. 

Intrigued at the prospect that an internet program could so completely replace me, I signed on to Legal Zoom.com and paid the money to generate my comprehensive, all-inclusive estate plan for the low, low price of $149. 

Well, first of all, it took what seemed like an eternity just to register and supply all of the information requested.  I could visualize other registrants, toiling like me, dropping off the site like flies. 

Do-it-yourself projects are so intimidating.  Even though I have over 30 years experience planning estates for others. I found myself questioning the accuracy of the answers I was giving the computer…as if I were an amateur!  I could only imagine what a lay person must be feeling. 

I couldn’t stop thinking about how obsessed some people are about saving money.  I don’t like paying the electrician or the dentist or the mechanic any more than the next guy, but I know it’s simply a reality of life that you’ve got to pay the  piper from time to time when stuff happens in areas of expertise that we’re clueless in.  Slaving away in this program seems so…so cheap feeling to me, and I’m one of the all-time, certifiable, world-class tight wads!  Just ask my kids and their mother and all of my employees.  

But come on…entrusting the disposition of my one-and-only, hard-fought estate to a machine that hasn’t even met me, doesn’t know about the dreams and aspirations I have for my children, my values, what strengths and weaknesses my children possess and how I want the future to look for them when there’s a pot of gold sitting at their feet?  

This legal zoom thing looks like it’s going to belch out some mighty pretty documents, but how in the world can they fit me correctly when the creator hasn’t so much as said “Boo” to me?  

 The further I go with this zoom program, the more uncomfortable I get, but I press onward to completion.  I know what I want, and I know that what I’m going to get back in the mail isn’t going to cut it.  The program just isn’t sophisticated enough to include all of the variables I need and want.  It’s not that I’m so complecated, it’s just that I know what should be part of a professional product that’s worth the money folks spend to get a professional result.  

I give seminars on estate planning almost every week all around the city.  People flock to them.  Why?  Can’t they go to the internet and do it all themselves?  Can’t they just go out and buy a fill-in-the-blank set of forms and save some dough?  

Sure, the internet is one of my competitors, but as long as there are careful, caring and conscientious parents out there that understand that good family inheritance planning is so much more than just a bunch of pretty papers, there will always be a need for truly customized planning that can occur only with personal interaction between client and attorney doing it the old fashion way…talking.   

I invite you to attend one of my up-coming seminars.  Simply go to the seminar page of this website to find one that fits.  You’ll be amazed at how many interesting ideas there are out there that you can use to leave your estate to your family in the proper way and protect yourself all along the way. I’ll teach them to you.  You’ll understand.  We’ll talk.

Filed under: Medicaid, Trusts by Richard Hughes
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The trust that Mary sets up could be either revocable or irrevocable. The type of trust that Mary would set up would depend on a number of different circumstances, both personal and financial. An irrevocable trust would afford asset protection with respect to problems the other children may have over the years, including divorces, lawsuits, debt problems and irresponsible behavior. A revocable trust will not offer those protections, but is easier to maintain and administer over the years. Counseling with the family will help determine which way to go here. (more…)

Filed under: Medicaid, Trusts by Richard Hughes
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As I mentioned in my previous blog, giving assets away to a trust that you set up for yourself is probably not the way to go in today’s strict Medicaid world. It’s this type of “self-settled” trust that the Medicaid folks are coming down on hard. Instead, give assets away to your children as a group or to your most trusted child and have that child or your children hold the money for your future needs.

Here’s how it would work. Let’s assume you owned a house worth $200,000 and savings of $200,000. Let’s also assume that you have 4 children. Let’s also assume that all 4 children were pretty darn good, but one of them, Mary, was the most responsible of the group. Give away your house and your savings to Mary. She would then hold what you have given her in her own name for a couple of months. She would then create a trust on her own and transfer the house and the money that you gave her into this new trust. This trust would be held by Mary, as the trustee, with provisions stating that no assets could be transferred out of that trust for either a specific period of time or, perhaps, until your death. When you die, Mary could distribute the assets in equal shares to herself and to her siblings.

Transferring assets from your name directly to a child’s name will cause a Medicaid penalty period, but your plan is to give the assets away and stay out of a nursing home for or five years. After five years, the gift would be invisible to Medicaid. They only ask, when you apply for Medicaid later, if you’ve made any gifts within the last five years. If five years passed when you make application for Medicaid, the gift to Mary would not be “visible.”

You would also answer “no” to the questions of whether or not you are a current beneficiary of a trust. Since Mary set up the trust after she received the gifted property from you, you were not the one responsible for setting up the trust and you’re not currently named as the beneficiary of any trust. In fact, the trust Mary sets up names herself and her siblings as beneficiaries of the trust, not you. You might be given some power to authorize distributions of money out of the trust to your children even though you are not a current beneficiary of that trust by naming you as a special independent trustee with certain powers over the distribution of assets. Stay tuned for more later.

Filed under: Medicaid, Trusts by Richard Hughes
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As a follow up to my first post, I want to elaborate a bit on what I believe is Medicaid’s position with regard to the use of irrevocable income-only trusts by those folks seeking to protect their assets from nursing homes and Medicaid Estate Recovery in the event of a nursing home stay.

Medicaid allows for the use of income-only irrevocable trusts as a way to shelter assets and as an alternative to outright gifts of assets to children. Therefore, many Coloradans have transferred assets to these trusts with the expectation that the assets transferred would not be considered as available resources when they later apply for Medicaid assistance when a nursing home becomes necessary. Over the last couple of years, however, Medicaid has been much tougher in their review of these trusts before Medicaid is granted to an applicant. Medicaid is now saying that any irrevocable trust that confers any kind of a benefit to the Trustmaker will fail with the result that the assets in the trust will be considered available resources. This will result in the denial of Medicaid benefits because they will be considered “over resourced.” (more…)

Filed under: Medicaid, Trusts by Richard Hughes
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My law firm just won an important case in front of Judge C. Jean Stewert in the Denver Probate Court, but the State Medicaid bureaucrats are saying that they don’t care what the court ruled. They’re going to do what they want when it comes to the treatment of irrevocable income-only trusts and an applicant’s attempt to qualify for Medicaid. The case is complicated even to those well-versed in Medicaid law, so I won’t go into the details of the case now but will post the Court documents shortly so you can dig into the details if you choose. The main thrust of this post is to express my frustration with the Medicaid bureaucracy and publicly expose the arrogance they are now exhibiting with regard to their disregard of Court orders. They believe they are above the law and can ignore court orders that attempt to protect our poorer citizens. If you have an interest in seeing how these bureaucrats work the system, stay tuned. More later.

Filed under: Medicaid, Trusts by Richard Hughes
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