Planning for Life

US Agency Strengthens Protections for Nursing Home Residents

Posted by Elizabeth Stepakoff on October 28, 2016

By Rebecca J. Benson

The Center for Medicare and Medicaid Services (CMS) has announced its first comprehensiveAgingWaiver-resized-600.jpg overhaul of nursing home rules in over 20 years. CMS first promulgated nursing home regulations in 1989 and 1991 to implement the landmark Nursing Home Reform Law of 1987. CMS stated that the new regulations were necessary to reflect innovations in resident care and quality assessment practices, and to address the fact that the population of long-term care facilities has become more diverse and more clinically complex.

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Topics: long-term care planning, nursing homes

Case Illustrates, but Rejects, Doctrine of Merger in Trust Law

Posted by Harry S. Margolis on October 25, 2016

By Harry S. Margolis

In the case of Mond v. Pitts (Mass. App. Ct. 15-P-686, Aug. 19, 2016), the Massachusetts Appeals Court corrected an erroneous decision involving two trusts created by Lorenzo Pitts, Sr., who passed away in 2009. Lorenzo Sr. created the Esperanza Trust and the Fort Hill Trust, both of which held real estate in Roxbury. While the trusts had a second trustee and at one point the second trustee also owned 1% of one of the trusts, during his life, Lorenzo Sr. became the sole  trustee and sole lifetime beneficiary of both trusts. The trusts provided that at his death, "the beneficiaries shall be Lorenzo Pitts, Jr. and Robert Pitts, in equal shares." The trusts further directed that the trusts would terminate and that the property be sold and distributed "among the beneficiaries if living."

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Topics: trusts, Estate Planning

Housing: Is My Intellectually Disabled Child Likely to be Entitled to a State-Funded Group Home?

Posted by Karen B. Mariscal on October 22, 2016

When planning for the future, one of the questions that parents of intellectually disabled children will need to consider is where the child is likely to live as an adult, and who will pay for it. If the child will need life-long support and will not able to live on his or her own, some governmental assistance may be provided, but how much?

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Topics: special needs planning

What's a Trust and Why are There So Many Different Kinds?

Posted by Harry S. Margolis on October 18, 2016

By Harry S. Margolis

A trust is a legal entity that permits one or more people -- the "trustee" or "trustees" -- to manage property for the benefit of other people -- the "beneficiaries." The third actor in a trust is the person who creates it -- the "grantor" or "donor." To confuse things a bit further the same person can be a grantor, trustee and beneficiary, but he can't be the only one in all three roles. And the property in the trust can be just about anything you can own -- real estate, bank accounts, investments, or artwork.

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Topics: special needs planning, Estate Planning

Personal Care Attendants: Valuable Help for Parents of Disabled Children

Posted by Karen B. Mariscal on October 17, 2016

MassHealth funds a Personal Care Attendant (a/k/a Personal Care Assistant), or PCA, program in order to help recipients with long-term disabilities manage their own in-home day-to-day personal care. Under this program, a PCA is hired at a rate of $14.12 an hour (in 2016) to physically assist with both activities of daily living, or ADLs (mobility, bathing, dressing, passive range-of-motion exercises, taking medications, eating, and toileting), and instrumental activities of daily living, or IADLs (laundry, meal preparation and clean up, shopping, housekeeping, traveling to medical appointments, and other special needs).

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Topics: special needs planning

CMS Protects Nursing Home Residents’ Right to a Jury Trial

Posted by Rebecca J Benson on October 17, 2016

Frail nursing home residents and their stressed family members are routinely asked to sign a stack of densely-printed documents at the time of admission, without adequate time to review them or consult with counsel. They often do not realize that the agreements include binding arbitration provisions. Although this might sound benign, arbitration requires a waiver of the fundamental constitutional right to a jury trial, even if the resident later suffers serious injury, medical malpractice, or wrongful death. 

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Topics: long-term care planning

MassHealth Planning and Real Estate

Posted by Harry S. Margolis on October 11, 2016

I. MassHealth Eligibility and the Family Home

A. Long-Term Care Planning

For all practical purposes, in the United States the only "insurance" plan for long-term institutional care is Medicaid (called “MassHealth” in Massachusetts). Medicare only pays for approximately 20 percent of nursing home care in the United States. Private insurance pays for even less. The result is that most people pay out of their own pockets for long-term care until they become eligible for MassHealth. While Medicare is an entitlement program, MassHealth is a form of welfare -- or at least that's how it began. So to be eligible, you must become "impoverished" under the program's guidelines.

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Topics: long-term care planning, MassHealth

Housing Models for Adults with Intellectual Disabilities Who Are Not in State-Supported Housing

Posted by Karen B. Mariscal on October 8, 2016

The majority of adult children with significant intellectual disabilities live with their parents or other family members through the child’s 40s, and often 50s. (For purposes of this article, we will refer to the provider as the parent, and the adult with special needs as the child, although this article applies to siblings and other relations as well.) Only about a third of all intellectually disabled citizens in Massachusetts are served by the Department of Developmental Services (DDS) receive housing provided by the state. These people -- tending to be the older or more serious cases -- are considered Priority One for housing by DDS. All other DDS clients are either Priority Two on No Priority. Click here for a description of state-supported housing.

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Topics: special needs planning

Using Annuities in MassHealth Planning for Nursing Home Residents

Posted by Harry S. Margolis on October 4, 2016

By Harry S. Margolis

Immediate annuities have long been used in long-term care planning as a means of transforming assets that are countable against the limits for MassHealth eligibility into an income stream that does not affect eligibility. This primarily benefits spouses of nursing home residents, but can be used for single nursing home residents as a form of “arbitrage,” in effect to pay the MassHealth rather than the private-pay rates charged by nursing homes. 

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Topics: MassHealth planning, long-term care planning, MassHealth

Funding a Special Needs Trust With Life Insurance

Posted by Karen B. Mariscal on September 26, 2016

Leaving your special needs child with enough money to pay for their needs after you are gone can be a daunting task. The costs of providing a home and care exceed the resources of most families. Often a good solution is to fund a special or supplemental needs trust (“SNT”) with life insurance. A parent can take out a life insurance policy on his or her life to ensure that once the parent is gone, monies will be available to care for the special needs child.

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Topics: special needs planning

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