Centers for Medicare & Medicaid Services (CMS) has issued stricter requirements for COVID-19 testing in nursing homes, making routine staff testing a requirement for participation in Medicare and Medicaid and rolling out fines as high as $8,000 per instance of non-compliance.

“These new rules represent a dramatic acceleration of our efforts to track and control the spread of COVID-19,” CMS administrator Seema Verma said in a statement announcing the requirements.

“CMS recommendations for the frequency of staff testing will be based on the degree of community spread, to be announced shortly through guidance, that indicate the facility may be at increased risk for COVID-19 transmission,” the agency noted.
​
Nursing homes must now also provide tests to residents during all outbreaks, as well as when residents show any symptoms of the viral infection.

CMS pointed to the most recent round of $5 billion in federal CARES Act relief set aside for nursing homes — on top of billions in other aid available to post-acute and long-term care providers — as a key source of funding to cover testing expenses under the new rules.

​Is it time for a nursing home? It may be just what's needed

You've been caring four your Dad for several years and you realize that it may be time for a nursing home.
 
Don't look at it like it's something you're doing to them but something you're doing for them.
 
It's something many of us have heard our parents say... don't ever put me in a nursing home... to which you reply. I won't

Fast forward a decade or so. Your Dad now suffers from Alzheimer's, you've cared for him in your home for as long as you can. You're physically exhausted and mentally fried.

There's a nursing home near you, it's a spacious, cheerful and you've heard good things about it.

You think of putting your Dad on the waiting list so that he could have professional care he needs and you could work on your own health along with seeing him as often as you wish. But, the elephant in the room is that promise you made years ago. "I'll never put you in a nursing home."
 
However, the most important thing to consider is that you must provide your loved ones with the best care possible under the circumstances that they - and you - face. That, my friends, is the "spirit of the promise that you made".

What you must do now is look at the facts and ask yourself the following questions;

• Is your Dad safe under your care? Can you stay completely awake and alert 24/7 in case he uncharacteristically wanders? Think of the guilt you'd feel if he walked off when you were sleeping and got hurt or lost. That would rip your heart out more than obtaining help with his care ever could.
• Is your Dad getting the peer interaction he needs? He and you are together day and night but does he see any of his friends?
• Are you spending most of your time providing physical care or do you have time to be a "daughter" and laugh, hug and spend quality time with your Dad? 
• How about your own health? Is your energy completely drained? are you filled with stress? Do you take time to meet with friends or exercise? Are you eating properly? These are signs that you may be completely ignoring your own well being.

 
Will any nursing home be perfect? No. That's where family comes in. Visit often. Bring in special treats that go beyond what the nursing home can be expected to provide. Save that ever important listening ear for your Dad. Those are very caring things that you can still do. 

Remember, the most important thing is to ensure that your loved one receives the care they need - at a facility, your loved one will receive the care they need 24 hours a day seven days a week from professional trained staff members.

While it may be sooner than you wanted, it may also be later than you should have - a nursing home may eventually be the best place for your loved one.

A New Jersey Medicaid applicant who paid home health care aides with checks made payable to cash is now ineligible for Medicaid benefits.
 






​D.Z. v. Ocean County Board of Social Services (N.J. Super. Ct., App. Div., No. A-5962-17T3, June 23, 2020).
 
D.Z. paid individuals for home care assistance for several years prior to applying for Medicaid benefits.
 
After the application was submitted the caseworker issued a penalty period for payments made to the individuals because there was no formal written agreement in place.
 
The total amount - $210,579
 
What does this mean?  
D.Z was not eligible for Medicaid for approx 600 days because the funds were considered a non compensated transfer and since she is now in a nursing home that will equate to approx. $220,000 of costs owed to the nursing home.
 
Why were they a non compensated transfer?  because the checks were paid in cash and there was no formal written agreement.
 
If she were to have consulted with a Medicaid specialist she would have learned that in order to pay an individual for care needs who is not from a professional company, a properly worded written agreement is required by Medicaid rules.
 
 
The Long Term Care Medicaid program is very complex. Please consult with a Medicaid expert for proper planning.
 
Questions about Medicaid Planning?  contact us today  855.471.6771   [email protected]

Unfortunately, nursing homes across the country have been hit hard by the COVID-19 outbreak.
 
An analysis of data by The CDC puts the number of deaths in nursing homes and other long-term care facilities at close to 50,000.
 
However, by taking action quickly and early, the Maryland Baptist Aged Home in West Baltimore, a 100-year-old nursing facility has had no coronavirus infections.
 


The Maryland Baptist Aged Home is considered the oldest African American owned and operated nursing home in the state. It has 30 residents and 21 full-time and 19 part-time employees. It is governed by the United Baptist Missionary Convention.
 
Rev. Derrick DeWitt, pastor of First Mount Calvary Baptist Church in Sandtown-Winchester, has been chief financial officer and director of the home for seven years.
 
His first hire after taking the job was a nurse who specialized in infection prevention and quality control. That nurse, Nioca Osbourne, established protocols for dealing with infections and trained the staff.
 
Because of that, “We already had procedures in place for dealing with infections,” Reverend DeWitt says.
 
But how did they avoid the infections?  In late February, after hearing news from President Trump, DeWitt believed the country faced a deadly threat of unpredictable scope. He took immediate action.
 
“The first thing we did was eliminate all visitations,” he says. “So family, volunteers, the church people who visit were all told they could not visit. It wasn’t too popular at first, but they understood it was for the safety of the residents.”
 
“The next thing we did was eliminate residents going out unless it was for a crucial medical procedure. All employees who were not involved in direct care were told to stay home and work from there if they could. I personally have not been inside the nursing home for 11 weeks.”
 
The home stocked up quickly on extra masks, gloves and gowns. DeWitt scheduled his janitors so that the nursing home received thorough cleanings day and night.
 
He asked each staff member involved in the care of residents to limit travel and contact with their family members. On reporting for work, staffers had to fill out a questionnaire about their outside activities and health conditions.
 
“And we took their temperature three times a day,” DeWitt says.
 
Masks were dispensed to all the residents. Community meals were eliminated, and residents ate in their rooms. Employees were provided food so they would not have to go out for lunch or dinner. Rooms with one television and two residents got a second TV to help meet social distancing.
 
The nursing home hired an extra activities coordinator to visit with residents, coach them through daily exercises, play board games with them or take them for walks. This was particularly important because, says DeWitt, up to half of his residents have no relatives who visit them, and he was concerned they would feel even more isolated during the pandemic.
 
DeWitt and his staff did all this before seeing directives from government agencies. “We didn’t wait for guidance from the Centers for Disease Control or from the Maryland Department of Health or from Baltimore City,” he says.
 
“We did what we thought was prudent at the very beginning of the pandemic.” He gives credit for a team effort to the nurses and their assistants, the nursing director, Josephine Mungin; the home’s administrator, Johana Walbourn; the medical director, Dr. Narender Bharaj; the janitorial staff, dietician, food staff, social worker and therapists.
 
DeWitt says there will be no changes any time soon, no loosening up of the restrictions he put in place in February and March.
 
Like many of the health professionals he listens to, DeWitt thinks it’s too soon for that for his vulnerable residents.
 
“But we have allowed porch visits,” he says. One at a time, residents are allowed to come out on the nursing home porch and speak to relatives on the sidewalk 12 to 18 feet away.

​“My own aunt, Aunt Gerri Alston, is a resident,” DeWitt says. “She came out on the porch and cried. She was happy to see us.”

Questions about how to pay for nursing care?  contact us today  855.471.6771  [email protected]

​Medicaid 102
​Eligibility Basics
by Paul Lorrah
 
If an elderly relative needs to qualify for Medicaid in order to pay for long-term care costs, including at an assisted living facility or nursing home, where do you start?

​






We first have to determine if the individual is currently eligible for Medicaid benefits and if not, what needs to be done in order for them to be eligible.
​
Eligibility is determined by 3 categories;

• income,
• assets and
• medical needs

 
Additionally we have to look at the individuals marital status to determine if assets and income need to be preserved for the spouse.

Asset and income preservation strategies for the spouse in imperative to ensure that they can sustain their current lifestyle and have funds for their future needs.
​
Asset preservation is available for single individuals as well to;

• ensure that their wishes for family members to receive a portion of their assets when they pass,
• preserve funds for their future use once on Medicaid

Medicaid eligibility figures differ by state and for single or married individuals.
In Delaware and New Jersey a single person can have no more than $2,000 to be eligible. In Maryland it's $2,400 and in PA. it's up to $8,000 [depending on income].

Note, if a single individual has more than that, it does not mean they cannot apply for Medicaid. it just means they have to go through a Medicaid planning and asset protection strategy process to get to the eligibility levels needed.

Married applicants can retain more, the amount is determined by their total assets owned by both spouses.

Additionally, some states have a cap on the amount of Gross income a person can have. If their income is too high they're not eligible for Medicaid benefits and must utilize a Qualified Income Trust to pass their income through.

Medicaid has a 5 year look back period for all financial transactions. That means when a person applies Medicaid will require a record of 5 years of all financial transactions to determine if you have given any money to other individuals. If so, this may disqualify a person from benefits. Have no fear if you have, there are strategies available that may "fix" many of these issues if you have.

Once approved, the individual's assets must remain below $2,000 for their lifetime and if a Qualified Income Trust is required, this must be properly maintained each month as well.

As you can see, Medicaid has many layers, the one's mentioned above are only a few. The process is lengthy, time consuming and 93% of all individuals who apply without a skilled Medicaid expert as their advocate get denied.

If you have a loved one that you feel will need long term care such as nursing home or assisted living within the next 5-10 years, please contact us as soon as you can to begin the planning process.

The sooner you plan, the more options you will have.

If you have a loved one that will need long term care now or within the next 6 months - call us now!!

It's imperative that you get the answers and help that you need.

Our office has helped thousands of families with the Medicaid process, we will get the results you need.
​
Call today!  855.471.6771   or email us   [email protected]

​Medicaid 101
What is Medicaid
By Paul Lorrah
 
Medicaid now covers health care and long term care - today we're focusing on the long term care Medicaid program.








Medicaid is a joint federal and state funded program designed to pay for long term care costs associated with aging or a disability.

Long term care costs rise significantly each year. The average cost of a nursing home is $10,500 per month.
This is much more than most people can pay for any length of time.

Medicaid has become the long term care insurance source for middle class Americans.
 
Medicaid - also known in some states as LTSS [Long Term Services and Supports] is the largest source of LTSS funding in the country.

Currently Medicaid covers more Americans than any other health insurance program. 76% of all individual receiving care at a nursing home utilize the Medicaid program to pay their bills.

Medicaid is NOT welfare, it's part of the Social Security Act and was created in 1965. Originally intended solely for the cost of long term care.

The Medicaid program is the only program that will pay 100% of a person's nursing home costs [and in some states assisted living and at home care costs].

Medicaid does however have strict eligibility guidelines for income, assets and medical needs.

Please read or next blog - Medicaid 102 - Eligibility basics


then call us at 855.471.6771 or email  - [email protected]

The Centers for Medicare & Medicaid Services (CMS) announced new guidance for state and local officials to ensure the safe reopening of nursing homes across the country.






​​The guidance details critical steps nursing homes and communities should take prior to relaxing restrictions implemented to prevent the spread of COVID-19, including rigorous infection prevention and control, adequate testing, and surveillance. The recommendations allow states to make sure nursing homes are continuing to take the appropriate and necessary steps to ensure resident safety and are opening their doors when the time is right.

CMS is recommending that nursing homes do not advance through any phases of reopening or relax any restrictions until all residents and staff have received results from a baseline test.  In addition, CMS recommends that state survey agencies inspect nursing homes that experienced a significant COVID-19 outbreak prior to reopening.  Finally, CMS recommends that nursing homes remain in the current state of highest restriction even when a community begins to relax restrictions for other businesses, and should be among the last to reopen within the community, to ensure safety of the residents.  Nursing homes may receive visitors during phase three, which is when there has been a sustained decrease in COVID-19 cases. A variety of factors must go into making this decision, including states not only relying on case count, but assessing the individual nursing home and other local factors. Visitors must be screened and wear a cloth face covering at all times.

The new guidance encourages state leaders to collaborate with the state survey agency and local health departments to decide how these criteria should be implanted.  Given the critical importance in limiting COVID-19 exposure in nursing homes, CMS recommends that decisions on relaxing restrictions be made with careful review of the following facility-level, community, and state factors:

• Status of COVID-19 cases in the local community
• Status of COVID-19 cases in nursing homes
• Adequate staffing
• Baseline test of all residents, weekly testing of all staff, practicing social distancing, and universal source control   for residents and visitors (e.g., face coverings)
• Access to adequate personal protective equipment (PPE)
• Local hospital capacity

​

State and local leaders are urged to regularly monitor the factors for reopening and can adjust their plans accordingly, depending on local data about the circulation of the virus in their community.

The New Guidance for Nursing Home Reopening Recommendations for State and Local Officials is attached below

Questions about Medicaid Planning, Long Term Care Planning and Medicaid Applications?

Contact us today for a FREE consultation.  855.471.6771     [email protected]   

Medicare and nursing homes, what is covered
By:   Paul Lorah

Many people believe that Medicare will cover all of their costs when they enter a nursing home. However, Medicare's coverage is very limited as we will review here.


​
Who receives Medicare? 
Any person who has reached age 65 and who is entitled to Social Security benefits is eligible for Medicare Part A without charge. That is, there are no premiums for this part of the Medicare program.

What nursing home coverage does it offer?
Medicare Part A covers up to 100 days of "skilled nursing" care per spell of illness. However, the conditions for obtaining Medicare coverage of a nursing home stay are quite stringent. Here are the main requirements:

• The Medicare recipient must enter the nursing home after a hospital stay (meaning admission as an inpatient; "observation status" does not count) that itself lasted for at least three days [three 24 hour cycles, not counting the day of discharge].
• The care provided in the nursing home must be for the same condition that caused the hospitalization [or a condition medically related to it].
• The patient must receive a "skilled" level of care in the nursing facility that cannot be provided at home or on an outpatient basis. In order to be considered "skilled," nursing care must be ordered by a physician and delivered by, or under the supervision of, a professional such as a physical therapist, registered nurse or licensed practical nurse. Moreover, such care must be delivered on a daily basis.                                               

In the event the nursing facility determines that a patient is no longer receiving a skilled level of care, the Medicare coverage ends.

This coverage lasts for the first 20 days of nursing home care, beginning on day 21 there is a significant co-payment equal to one-eighth of the initial hospital deductible ($161 a day in 2016). This co-payment will usually be covered by a Medigap insurance policy, provided the patient has one.                                                                                             
A new spell of illness can begin if the patient has not received skilled care, either in a Skilled Nursing Facility (SNF) or in a hospital, for a period of 60 consecutive days. The patient can remain in the SNF and still qualify as long as he or she does not receive a skilled level of care during that 60 days.                                                                                
Nursing homes often terminate Medicare coverage for SNF care before they should. Two misunderstandings most often result in inappropriate denial of Medicare coverage to SNF patients.

First, many nursing homes assume in error that if a patient has stopped making progress towards recovery then Medicare coverage should end. In fact, if the patient needs continued skilled care simply to maintain his or her status (or to slow deterioration) then the care should be provided and is covered by Medicare.                                                                       
Second, nursing homes may wrongly believe that care requiring only supervision (rather than direct administration) by a skilled nurse is excluded from Medicare's SNF benefit. In fact, patients often receive an array of treatments that don't need to be carried out by a skilled nurse but that may, in combination, require skilled supervision. In these instances, if the potential for adverse interactions among multiple treatments requires that a skilled nurse monitor the patient's care and status, then Medicare will continue to provide coverage.                                                             
When a patient leaves a hospital and moves to a nursing home that provides Medicare coverage, the nursing home must give the patient written notice of whether the nursing home believes that the patient requires a skilled level of care and thus merits Medicare coverage. Even in cases where the SNF initially treats the patient as a Medicare recipient, after two or more weeks, often, the SNF will determine that the patient no longer needs a skilled level of care and will issue a "Notice of Non-Coverage" terminating the Medicare coverage.                                                     
Whether the non-coverage determination is made on entering the SNF or after a period of treatment, the notice asks whether the patient would like the nursing home bill to be submitted to Medicare despite the nursing home's assessment of his or her care needs. The patient (or his or her representative) should always ask for the bill to be submitted. This requires the nursing home to submit the patient's medical records for review to the fiscal intermediary, an insurance company hired by Medicare, which reviews the facilities determination.                              
The review costs the patient nothing and may result in more Medicare coverage. While the review is being conducted, the patient is not obligated to pay the nursing home. However, if the appeal is denied, the patient will owe the facility retroactively for the period under review. An appeal beyond this would involve an attorney.

Author Paul Lorah is a Medicaid and Long Term Care Planning expert who has authored such books as "Planning and Paying for Long Term Care' and "How to Get Medicaid to Pay for Your Long Term Care Costs". ​

More and more people are coming to us with the same problem... "The bank won't accept my power of attorney documents"...
 
You think you've done everything right, you went to an attorney and had a Power of Attorney [POA] document drafted so you can help your parents when the time comes and what happens when you get to the bank or call the life insurance company? More and more we see that financial institutions won't accept a POA document that's more than 1 year old. [Met Life just told us today that they won't accept a POA that's older than 60 days].
Some banks will allow you to sign their own POA form [valid at their bank only], but that may not help because the individual you are assisting may not be competent to sign legal documents.
Why do financial institutions do this?  Mostly due to liability. They are leery of older documents because they assume that it's possible that the individual granting the authority [Grantor] of the document may have changed their mind and possibly had a new document drafted changing the Agent [individual having the Power] and also due to the growing concern and awareness of Elder Financial Abuse.
See a recent article in the NY Times                                                                                                                               
What should a frustrated family do if this happens to them? Call us immediately, we can discuss the option of having us contact the institution that you are having issues with. We can usually resolve the issue.                              
How can we protect ourselves and be sure this won't happen to us? Have your POA documents renewed annually. I know this sounds like a hassle but it will save you even more aggravation and stress when it comes time to need them. Some attorneys will offer this as a FREE service. It may be included in the cost of your initial drafting of the documents. Annual review and signing of new documents is commonly included for the lifetime of the individual.                                                                                                                                                                         
Our office does offer this FREE service to our clients. Each year the individual that we drafted the documents for can come in and will review their circumstances and if anything has changed we will make the necessary updates. All documents are updated with a current date and they receive a new copy.                                                                
Having your documents updated annually is the best way to avoid this issue. That's why it's so important to have a local elder law attorney draft your documents as opposed to the internet. The internet cannot help you if you have issues or need that extra service that a local person can give you.
 
Questions?  contact us today... 855.471.6771