Facing the Reality of Long-Term Care
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About this ebook
You are and should be worried about the cost of long-term care.
You are reading this book because you are concerned, perhaps worried to your wits' end, about getting and paying for quality long-term care for yourself or a loved one. You are looking for reliable, understandable information about options, different levels of care, and how the potentially devastating cost can be paid.
This book will deliver. Based on over 40 years’ experience, the authors answer your questions and give you the information you need to develop a plan that works for you. It is "agnostic," in that it does not presume a solution for any given situation. It identifies the three ways the cost can be covered – paying out of your own pocket or "self-insuring," purchasing long-term care insurance, or looking to Medi-Cal and other government programs that can pay all or part of the cost of long-term care. Often, it is a combination of two or all three of these approaches.
The authors appreciate that these challenges are difficult and emotional. Their goal is to make this complicated world of long-term care – and long-term care financing – manageable for you and your family.
Michael Gilfix
Michael Gilfix is a nationally known authority in the field of law, aging and estate planning. A 1973 graduate of Stanford Law School, he is a Fellow of the National Academy of Elder Law Attorneys (NAELA), a co-founder of NAELA, and a Certified Legal Specialist in Estate Planning, Trust and Probate Law. Mr. Gilfix regularly addresses professional audiences, including attorneys, physicians, certified public accountants, and financial planners, nationally as well as locally.An entrepreneur in the legal field, Mr. Gilfix created the first legal aid program for elders in 1973. He served as Executive Director of that program, Senior Adults Legal Assistance (SALA) of Santa Clara County, for ten years. In 1983 he created the law firm that is today known as Gilfix & La Poll Associates LLP.For over 30 years, Gilfix & La Poll Associates has innovated creative legal solutions to help you manage and plan the future of your estate. Together, we will decide which strategy will best serve your individual needs and those of your beneficiaries. Their future is in your hands and it’s a privilege for us to serve you in this regard.Mr. Gilfix has been a principal speaker for numerous trust and tax symposia at the national level, including the Center for Judicial Education, the American Institute of Certified Public Accountants (AICPA) the New York University Tax Institute, and the National Academy of Elder Law Attorneys (NAELA).Mr. Gilfix is a California legal advisor to Partnership For Caring, the national organization devoted to rights of individuals to make their own health care decisions.A highly respected practitioner and a prolific author, Mr. Gilfix is co-author of Tax, Estate & Financial Planning for the Elderly: Forms and Practice (Matthew Bender) and is the principal author of Medi-Cal and Asset Preservation, a book- length set of materials for practicing attorneys. He regularly contributes to a wide variety of legal journals such as Trusts and Estates Magazine, where his writings have discussed the role of personal values in estate planning, life care communities, and asset preservation planning.Mr. Gilfix holds an AV rating from Martindale-Hubbell, as judged by his peers in the legal profession. This rating, the highest given “... reflects an attorney who has reached the heights of professional excellence, ... has practiced law for many years, and is recognized for the highest levels of skill and integrity.”Mr. Gilfix is a member of the National Academy of Elder Law Attorneys’ Council of Advanced Practitioners. NAELA guidelines state that an attorney must be preeminent in the field of elder and special needs law to hold this title. Mr. Gilfix has a reputation as an experienced, outstanding, and exceptionally skilled elder and special needs law attorneys
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Book preview
Facing the Reality of Long-Term Care - Michael Gilfix
YOU ARE AND SHOULD BE WORRIED ABOUT THE COST OF LONG-TERM CARE.
You are reading this book because you are concerned, perhaps worried to your wits' end, about getting and paying for quality long-term care for yourself or a loved one. You are looking for reliable, understandable information about options, different levels of care, and how the potentially devastating cost can be paid.
This book will deliver. Based on over 40 years’ experience, the authors answer your questions and give you the information you need to develop a plan that works for you. It is agnostic,
in that it does not presume a solution for any given situation. It identifies the three ways the cost can be covered – paying out of your own pocket or self-insuring,
purchasing long-term care insurance, or looking to Medi-Cal and other government programs that can pay all or part of the cost of long-term care. Often, it is a combination of two or all three of these approaches.
The authors appreciate that these challenges are difficult and emotional. Their goal is to make this complicated world of long-term care – and long-term care financing – manageable for you and your family.
Facing the Reality of Long-Term Care
Capturing Quality, Avoiding Bankruptcy
MICHAEL GILFIX, ESQ.
&
MARK R. GERSON GILFIX, ESQ.
A Gilfix Education Publication
www.Gilfix.com
FACING THE REALITY OF LONG-TERM CARE
Copyright © 2014 by Michael Gilfix
All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means without written permission from the author.
ISBN 978-0-9960312-1-9
Gilfix & La Poll Associates, LLP
2300 Geng Road, Suite 200
Palo Alto, CA 94303
650-493-8070
www.Gilfix.com
Acknowledgements & Dedication
Any consequential book is, at heart, a team effort. I received invaluable assistance from attorneys Francis A. La Poll and Myra Gerson Gilfix. Also essential was assistance from Ashleigh Alcock and other members of our remarkable team at Gilfix & La Poll Associates, LLP.
This book is dedicated to the memory of two individuals who played critical roles in my earliest professional evolution. One is Diana Steeples, an employee of the City of Palo Alto, California in 1973. She encouraged and welcomed me as I established the free legal services program for elders that became Senior Adults Legal Assistance (SALA). With her help, I saw my first clients at the Palo Alto Senior Center, which was then a desk in a downtown library.
This book is also dedicated to the memory of Murray Halwer. Murray moved to Palo Alto after retiring from a diversified legal career in New York City. He was one of the most vigorous volunteers Senior Adults Legal Assistance (SALA) ever had.
Michael Gilfix
September, 2014
Table of Contents
Who We Are
Why We Wrote this Book
What is Long-Term Care?
Three Trends that Worry Us about the Future of Long-Term Care Services
The Spectrum of Long-Term Care
Everyone Wants to Stay at Home
Assisted Living
Residential Care Facilities
Skilled Nursing Facilities (SNFs)
Continuing Care Retirement Communities (CCRCs)
Who Needs Skilled Nursing Care?
Paying the Cost of Long-Term Care
Your Pocket, Your Assets
Medicare
The Patient Protection and Affordable Health Care Act
Long-Term Care Insurance
Hybrid Long-Term Care Insurance
Medicaid, Medi-Cal
in California
Medi-Cal Myths & Reality
Medi-Cal, the Cost of Skilled Nursing, and the Medi-Cal Compliant
Annuities
Creative, Alternative Planning Options
The Child’s Perspective – Caregiver, Supporter, Inheritor
Too Late for Long-Term Care Insurance or Other Planning – What to Do?
Paying for Care: Good Options are Available
Plan to Stay Out of a Nursing Home, Receive Care at Home
Private Payment
Reverse Mortgages
Annuities to Ensure Income Stream
Long-Term Care Insurance
Veterans Aid and Attendance Care
In-Home Support Services
Medi-Cal Waiver Program: Program of All-Inclusive Care for the Elderly (PACE)
Life Care Contracts
Specially Drafted Estate Planning Documents
Family and Community Support
The Role of Technology in Home Care
Sensors
Robotics
Video Communication
Sources of Information
Information Overload
Unreliability
Different Laws, Different States
You are Aware of the Medi-Cal Program. Now What?
When Do You Seek Legal Advice?
Living at Home with Indications of Memory Loss and Dementia
Planning to Protect Your Residence
You Are About to Enter a Skilled Nursing Facility
You Are Already In a Skilled Nursing Facility
Act Now, the Law Will Change
Medi-Cal Eligibility
Single Individual
Married Couple – Protections for the Spouse Who is Still at Home
Protect Your Assets and Qualify for Medi-Cal
Protect Your Residence!
Court Petition to Increase Asset Protection for the Spouse Living at Home
Court Petition or Administrative Hearing to Increase Income Protection for Spouse Living at Home
Conversion of Nonexempt Assets to Exempt (Protected) Assets
Life Insurance
Retirement Accounts
Hire Family Members to Provide Services
Use of Annuities
Transfer of Cash and Other Nonexempt Assets
Ensuring Protection for the Nursing Home Resident
Other Strategies Exist
Tax Implications of Asset Preservation Planning
Gift and Estate Tax
Capital Gains Tax
Property Tax
Income Tax
Ensuring Quality of Care in Long-Term Care Settings
Cookies and Thorns
Nursing Home Ombudsman and State Inspection
Professional Care Management and Oversight
The Last Resort: Litigation
Relationships Matter
The Critical Role of Estate Planning Documents
One Stop Shopping: The Ideal LTC Planning Approach
An Objective, Professional Review of Your Situation
Assessment of Personal Finances to Identify the Optimal Blend of Long-Term Care Insurance, Investment Strategies, and Government Benefits Eligibility
Coordination of Home and Personal Care
Identify Appropriate Technology to Maximize Quality of Care and Security
Patient Advocacy
Financial Management – Trustee Services
What Can We Provide? How Close Are We?
In Conclusion, Be Proactive
Appendix: Directory of Organizations that Can Provide Assistance
Who We Are
MICHAEL GILFIX, ESQ.
Michael Gilfix is a nationally known authority in the fields of estate planning, elder law and Special Needs Trusts. Mr. Gilfix is a 1969 graduate of Stanford University, where he graduated with distinction and was elected to Phi Beta Kappa. Mr. Gilfix is also a 1973 graduate of the Stanford Law School.
Mr. Gilfix created the first free legal aid program for elders in the nation in 1973 and served as its director for ten years. That program, Senior Adults Legal Assistance (SALA), still thrives in Santa Clara County, California. He is a co-Founder of the National Academy of Elder Law Attorneys (NAELA) and a Fellow of the Academy. He was founder of California Law Center on Long-Term Care. He is also a Certified Legal Specialist in Estate Planning, Trust, and Probate Law. He is a founding member of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys. Mr. Gilfix is an Advisory Board Member of the Academy of Special Needs Planners (ASNP).
Mr. Gilfix is annually identified as a Super Lawyer in the field of Estate Planning and Probate. He is a Certified Specialist in Estate Planning and Probate by the State Bar of California.
Mr. Gilfix is a Contributing Editor for Elder Law for Trusts & Estates magazine. Mr. Gilfix is on the National Advisory Board of Elder Counsel.
He has been a principal speaker for numerous trust and tax symposia at the national level, including the American Institute of Certified Public Accountants (AICPA), the New York University Tax Institute, the Southern California Tax and Estate Planning Forum, the National Academy of Elder Law Attorneys, and the Academy of Special Needs Planners (ASNP).
A highly respected practitioner and a prolific author, Mr. Gilfix is co-author of Tax, Estate & Financial Planning for the Elderly: Forms and Practice (Matthew Bender). He regularly contributes to many other legal journals and publications, including Trusts & Estates and Estate Planning magazine. He is frequently