Elder law is an aspect of estate planning that focuses primarily on the needs of families and individuals as they age. Issues of aging include senior housing and home care, long-term (or nursing home) care, conservatorships and health care documents, Medicare and Medi-Cal.
As our population ages, more and more of us confront elder law-related issues, whether for ourselves or our parents. One of the most pressing issues is long-term custodial or nursing home care, neither of which is normally covered by traditional health insurance or Medicare. Depending on where you live and the level of care needed, nursing home care can cost from $35,000 to $150,000 a year. The average stay is slightly more than three years. Most people think they have to pay for nursing home care until their personal (or family) assets are depleted, and then try to qualify for Medi-Cal to pick up the cost.
Careful planning, however, can help protect your assets, whether for your spouse or for your children. The belt-and-suspenders approach is to purchase long-term care insurance while you are healthy enough to qualify, and to make sure you receive the benefits to which you are entitled under Medicare and (if absolutely necessary) Medi-Cal.
Clients are frequently confused over the differences between Medicare and Medi-Cal. Though their names are very similar, the programs are quite different. Medicare is an entitlement program, a federal health insurance program in which most people enroll when they turn 65 years old. There are no financial qualification rules. Medicare has two primary parts: Part A and Part B.
Medicare Part A covers in-hospital care, extended care after a hospital stay, some home health care services, and hospice services. The rules for nursing home coverage are very strict and, in fact, Medicare pays for less than 9 percent of nursing home care in this country.
Medi-Cal, is a joint federal-state program subject to certain federal requirements, but each state implements its own regulations on how the program is managed. Medi-Cal is not an entitlement program like Medicare, but rather a form of welfare. It is a means tested program for people with limited assets. Medi-Cal eligibility is determined after the proper application is submitted to the state. There are many Medi-Cal insurance programs available in California, but the firm’s focus is on Medi-Cal for long-term care.
We assist seniors and their families in making the tough decisions regarding long-term care planning, including whether Medi-Cal eligibility may be an option.
It is important to understand that, in general, Medi-Cal provides skilled nursing care in a shared room at skilled nursing facilities that accept Medi-Cal. Though there is a program called “In Home Support Services” to provide some level of in home care, that is a very small part of Medi-Cal, and does not provide sufficient funds for 24/7 care.
Helping a parent move to senior housing can seem more intimidating than orchestrating a rocket launch. The death of a spouse, declining health or safety concerns can trigger the need to move. The first phase comes with the realization that what has been home is no longer suitable; that realization usually is by family members long before the elder who needs to move accepts their need to move, as emotional ties to one’s home are hard to overcome. Finding a new home that is appealing and appropriate is no easy task, and neither is culling through a lifetime’s accumulation of "stuff."
Here are some tips to help make the transition easier: