Gainesville Florida Estate Planning & Elder Law Blog

Right now there is a common misconception that once the millennial generation reaches the age of their parents, there will be no money for them when it comes to health care and health-care benefits. A recent study was released that proved this theory wrong. In fact, if the government continues to spend what they are spending now and continue heading in the right direction, millennials can expect to receive more than double what their parents will receive in payments when they hit retirement.

The main reason for this pay increase is an expected upsurge in salaries over the next few years. Social Security benefits are raised when salaries are higher, which means more benefits for later generations applying to Medicare and receiving social security checks.

Projected high benefits might appear to reassure millennials that they will enjoy a strong federal safety net in their later years. Level patterns of government spending during the lifetime of millennials could improve living standards for younger Americans, while still providing Social Security and Medicare benefits to them during their later years.

Knee replacements are on the rise. A study done between 2000 and 2010 found that knee replacement surgery nearly doubled during that time. And according to the survey, knee replacement surgery was the leading inpatient surgery performed in 2010 by people age 45 and over. Yes, the baby boomer generation is getting more knee replacements than any generation before them.

Why are the numbers increasing?  The main reason is people aren’t waiting as long to get the knee replacement surgery done.  In the past, doctors often encouraged patients to wait for the surgery until the pain became debilitating.  But the new philosophy is to get the procedure done sooner to avoid the debilitating pain and to allow those receiving the surgery to maintain their activity level.

Recent improvements in the procedure have decreased the recovery time. A hospital stay can be down to 1 to 3 days. This all might impact insurance rates in the future considering that the second knee replacement will probably need to get done in 10 to 15 years which will increase the need for rehabilitation.

This new philosophy and procedure could have an impact on insurance rates down the road. And it will be interesting to see how well a patient will respond when a second replacement is needed after the joint wears out – usually between 10 and 15 years. One question for the future is whether there will be a need for longer hospital stays or longer rehabilitation when 80 and 90 year olds are receiving their second (or third) knee replacement?  

Retirement has changed its definition as time has progressed. It went from being something everyone looked forward to in order to relax, to something people dreaded because it only signified that they were getting old. Now retirement has taken another turn and for the better. Retirement these days means a break from the stress of work, and the start of a new chapter and possibly even more active lifestyle.

The stereotypes that come along with retirement tend to be negative. Most people close to retirement age worry that they will become boring, stay at home all day and end up being very lonely. The reality is that a lot of elders are reporting that retirement age might just be the best time of their lives.

Keeping active during your retirement age can not only keep a person happy but it can keep them extremely healthy at a time that they need it the most.

Unfortunately, it is often the case that nursing home residents are sent to a hospital when it is not necessarily needed. About one third of nursing home residents are sent to a hospital at least once each year. The numbers should be decreasing because the reasons for hospitalization can sometimes simply be solved within the nursing home.

The Center for Medicare and Medicaid Services recently announced that it is going to continue to push for the initiative to reduce nursing home hospitalizations that can easily be avoided.

The first thing to focus on is training of nursing home staff so that residents are not sent to a hospital for something as simple as a low-grade fever. Another common problem that needs to be resolved is that the nursing home should be equipped with the proper tools and resources to deal with medical problems.

In the past year, the number of hospitalizations has decreased thanks to this initiative. Hopefully the numbers will continue to decrease as time goes on.

When you die, there are a number of things that need to be taken into consideration. It is a fact that when it comes to your physical belongings, whoever you name in your will receives your belongings. However, when it comes to your digital estate, sometimes the fate of your social media accounts lies in the company themselves.

Each social media platform has different policies when it comes to the deceased. For example, Facebook gives your family members two options. Either one can deactivate your account, or it can be turned into a memoir where no one can log in or out.

There are certain things you can do to prepare your digital estate. You can write down a list of accounts you have, write down their passwords, keep your pictures on either iCloud or Dropbox, decide what you want done with your profiles and write out a list of instructions depending on what you wish to do.

One can start receiving social security benefits as soon as age 62. In order to make the decision of when to apply for these benefits, one must consider when the right time is in order to get the full benefits they will need.

In general, if one can postpone their application until they reach 70 years old, they will receive an 8 percent increase a year as far as benefits go. Looking at these statistics could assist you in making the decision that is right for you. If you are a married couple, it is also important to use strategies in order to increase the overall benefit as well.

For those born between the years of 1943 and 1954, at age 66, you are considered to be at “full retirement age” which basically means you’ll be getting a larger monthly benefit. Benefits will then increase until you hit age 70.

The system basically states, “You get a smaller payment for a longer amount of time, or a larger payment for a shorter amount of time.” Once this is understood, one can make an informed decision.

One thing to consider is life expectancy and this chart taken from Schwab.com can help

Other things to consider include, your income from other sources, combining your benefits with a loved one and your tax situation. Once you consider these things, you can make an informed decision on when to start receiving health care benefits.

Every decade, the White House hosts a Conference on Aging in order to advance the quality of life in older Americans. The conference was held in 2015 which is also the year celebrating the 50^th anniversary of Medicaid and Medicare. The conference collects information from different states and cities in order to find out what topics need to be covered in upcoming events.

This year, the main issues that were discussed were retirement security, healthy aging, long-term services and support and elder justice. In the 2015 budget, there was a proposed $3 million that is being used to support aging as well as new technology that will be utilized.

A major project that was implemented was a new one-stop shop for all aging resources. The website for the new services is www.aging.gov,  and the home page contains information on social security, Medicaid and more. The site is easy to navigate according to state and local information.

A personal services agreement permits an elderly person to pay adult children for caregiving while still preserving the eligibility of their long-term Medicaid benefits. The contract itself prevents lawsuits from happening and uncompensated transfers that count against the Medicaid eligibility.

When writing up one of these agreements, it is important to keep the following criteria:

The nature of services must be specific, there must be proof of payments, documentation must be provided, the recipient must pay income tax and the recipient must pay self-employment tax on the income. In order for the agreement to be accepted, it must meet all of these key elements.

Most of the time, paying a relative for care is the safest and most cost-efficient way to handle caregiving. However, it is crucial to know how to structure your agreement so that these arrangements can be made. And it’s always best to have a legal professional who concentrates in these areas to help you set up the agreement.

    When it comes to relevant laws that pertain to nursing home residents, the amount of knowledge the average person knows is very little. Unfortunately, Nursing Home Reform Law violations are all too common. Knowing common problems and solutions could keep both you and your family members safe. Here are numbers 11-20.

   #11. Refusal to Bill Medicare

Fact – Resident can insist on billing Medicare

Solution – One must first obtain Medicare eligibility and then after, the resident or a representative of the resident must make sure the billing process is sent to Medicare

    #12. Losing Therapy for Supposed Failure to Make Progress

Fact – Therapy is always appropriate, even when progress is not being made

Solution – A lack of progress is no reason to stop and should always be provided. It is consistent with the Medicare rules            

   #13. Losing Therapy After Medicare Payment Has Ended

Fact – Therapy should be provided regardless of the resident’s source of payment

Solution – Convincing the doctor to continue therapy should be the first step along with making sure the nursing home is following through with continuing the process

    #14. Forced Transfer within Nursing Home After Medicare Payment Ends

Fact – A Medicare bed can be occupied by a resident whose care is not being reimbursed

Solution – If a resident does not wish to leave the bed, he should assert his right to veto             

   #15. Refusal to Accept Medicaid

Fact –  A nursing home can certify additional beds for Medicaid payment

Solution- This problem ultimately requires early action and should be obtained before admittance to the facility

    #16. Refusal to Readmit From Hospital

Fact – A Medicaid resident has the right to a Medicaid bed regardless of the hospital stay length

Solution – The resident should never hesitate to assert their right to a Medicaid bed once they return from the hospital. If remittance is denied, the resident may file a complaint with the state.

    #17. Excessive Charges

Fact – A nursing home can only give extra charges if they were agreed to during admission

Solution – There are two options. The resident can first refuse to pay the extra charges with a written explanation. They can also make a complaint to the state agencies

    #18. Refusal to Support Resident and Family Councils

Fact – A nursing home must provide meeting space for resident and family councils

Solution – Strength in numbers. Residents should do their best to make sure the council can run a meeting

    #19.  Eviction Threatened for Being Difficult

Fact – Eviction is allowed for only six limited reasons: failure to pay, no longer needing care, when needs cannot be met, endangers others and the home going out of business

Solution – One must know the only reasons eviction is possible and stand firm when another reason is given

    #20. Eviction Threatened For Refusing Medical Treatment

Fact – Refusal of treatment alone is not a reason for eviction

Solution – Complaining to a higher level in this case is the only way

The Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act became law when it was signed by President Obama earlier this month. 

The law, which does not go into effect until Aug. 6, 2016, helps prevent patients from having to pay for a nursing home stay because they were classified as outpatients during their stay in a hospital. The law is designed to prevent Medicare beneficiaries from spending days in a hospital under an outpatient status, only to discover at discharge that because they were never admitted, any follow-up stay in a nursing home is not covered under Medicare.

The new law requires that hospitals inform patients under observation or outpatient status for more than 24 hours be informed of that within 36 hours. While that does not totally solve the problem, it does let patients know of the situation so, if they anticipate a nursing home stay, they can talk to the hospital about their status. The text of the law can be seen here.

When it comes to relevant laws that pertain to nursing home residents, the amount of knowledge the average person knows is very little. Unfortunately, Nursing Home Reform Law violations are all too common. The results could be harmful for residents. Knowing common problems and solutions could keep both you and your family members safe. Over the week we will note some of these. We start today with ten and the other ten next Monday.

    #1.  Discrimination against Medicaid-Eligible Residents

Fact – A Medicaid-eligible resident is entitled to the same service as any other resident

Solution – Always resist second-class treatment

    #2. Failing to Take Care Planning Seriously

Fact – Resident’s family has the right to participate in care plan 

Solution – Family should attend all care meetings to keep informed

    #3. Disregarding Resident Preferences

Fact – The facility must make adjustments to honor resident needs

Solution – The resident should voice any and all concerns regarding their needs and make sure they are fulfilled

    #4. Failing to Provide Necessary Services

Fact – The nursing home must provide all necessary care

Solution – Family members should make it clear that a shortage of staff or money is no excuse to provide less service to the resident

    #5. Improper Use of Physical Restraints

Fact – Physical restraints cannot be used as a form of discipline

Solution – The use of restraint can only be approved by the patient’s doctor and the patient. Making sure these rules are followed is vital

    #6. Improper Use of Behavior- Modifying Medication

Fact –  Medication can be used but only when the behavior is a diagnosed issue

Solution – The resident may feel free to say no at any point in treatment and family should monitor what drugs are being administered              

   #7. Excessive Use of Feeding Tubes

Fact – The use of a feeding tube is a last resort

Solution – There should never be hesitation to refuse a feeding tube if the resident is still able to eat with assistance

    #8. Imposing Visiting Hours on Families and Friends

Fact –  A resident’s family member can visit at any time

Solution – If the facility has strict visiting hours, you can tell them that the Reform Law allows family to visit at any time

    #9. Forcing Family and Friends to Take Financial Liability

Fact – A nursing home requires no one to be financially responsible except for the resident

Solution – One may volunteer to be financially responsible but make sure it is never forced and that the resident always makes the final decisions

    #10. Forcing Residents to Give Up Legal Rights and Commit to Arbitration

Fact – There is no good reason for an arbitration agreement to be signed

Solution – During admission, the form should not be signed in case of circumstance changes