The Legal Checkup Blog


Posted by Judith Flynn on Wed, Mar 28, 2012 @ 08:03 AM

Most seniors I speak with feel that they have worked hard their entire lives, and that they should not have to spend all of their hard-earned assets on nursing home care.  They would like to pass some assets on to their children or grandchildren.

The problem with this, however, is that without proper guidance and advocacy, many seniors are often rushed into an Asset Protection plan that “protects the assets from the nursing home" and "protecs the assets for their children or grandchildren" ... and leaves the senior unprotected and vulnerable.  They fall victim to the many misleading ads in print on the radio that make false claims about asset protection, use scare tactics that are simply unconscionable, or offer deep discounts to sign up "today only."  No attorney worth dealing with is going to use any of these tactics to get your business.  Let me explain.

There are THREE FUNDAMENTAL RULES that you must understand about ASSET PROTECTION ...

1) You have not “protected” an asset until you have given it away, either to a person or a trust, with no legal right to change your mind and take the gift back in the future.

2) There is a five-year lookback period, which means that MassHealth can look at all of your financial statements going back five years, and they will impose a penalty for any gifts you made during that five years.  So, the assets are not fully protected until FIVE YEARS after you give them away.

3)  You could unintentionally be forced to a nursing home if you run out of funds to pay for continued care in your home.  If you “protect” assets by giving them away and getting through the five-year lookback period as outlined above, you will have no legal right to get the assets back and you may be left "unprotected" and unable to pay for the care you need to remain in your home.  

Certainly it is not any senior's intent to end up having to move to a nursing home because they "protected" their assets years earlier ... but it happens.  Part of the problem, in my opinion, is the prevalence of misleading ads that serve to scare and confuse seniors.

BEWARE of legal ads that encourage you to “Protect your Assets” while leading you to believe you are protecting yourself in the process … this is one example of an ad that I find to be very misleading, if not absolutely FALSE.

Learn about Asset Protection Trusts that:

      1) allow you to control your assets until death;

      2) allow you to retain all income from your assets

      3) enable you to protect your assets from the nursing home

     4) ensure you qualify for Medicaid in the shortest period of time

Let’s look back at the Fundamental Rules of Asset Protection.

Number 1 is FALSE because, while you may serve as trustee of the asset protection trust, it is not YOUR assets that you are controlling ... you gave the assets to someone else in order to "protect" them!

Number 2 is FALSE because, while you can retain the right to the income generated by the assets in an asset protection trust, the assets in the trust are no longer YOUR assets!  You gave the assets to someone else in order to "protect" them!

Number 3 is TRUE and FALSE - True because after five years the assets will be protected from the cost of your nursing home care, but FALSE because, once again, they are not YOUR assets any more -- you gave them to someone else in order to "protect" them.

Number 4 is FALSE because there is a 5 year lookback.  Assets transferred to an asset protection trust will not be fully protected until 5 years after they are transferred to the trust, and there is no attorney who can make you eligible with this strategy in less than 5 years.  In fact, there may be ways to make you eligible sooner based on your specific situation, but not with an asset protection trust.

Some asset protection strategies may be appropriate for you, but only if you can ensure your own future security in the process.  This is why a comprehensive assessment of your specific family situation, health and care needs, income and assets, and goals is critical to a successful Long-Term Care Plan.  A Legal Check Up will enable you to fully understand the risks and benefits and pros and cons of asset protection strategies, and will enable you to make an informed decision based on your specific situation.  

Remember, if a radio or print ad seems too good to be true, it probably is. And, if an attorney offers a discount on the cost of an asset protection plan, but the price is good "today only ..."  RUN, don't walk, to another elder law attorney.  These pressure and scare tactics are not appropriate and, frankly, offensive to most elder law attorneys. Your future security must be treated with the importance and thoughtful deliberation it deserves, by you and your attorney.

Call us today at 781-681-6638 to schedule a Legal Check Up or to get a schedule of upcoming seminars, or get more information at

Tags: PACE, home care, long-term care, asset protection, elder law, Legal Check Up, Legal Documents, Estate Planning, disability planning, Medicare, Community Care, Elder Financial Abuse, family, loved ones, priorities, Medicaid, Medicaid Home Care


Posted by Judith Flynn on Sun, Jan 15, 2012 @ 15:01 PM

I've heard many excuses for putting off long-term care planning, including:

Because ...

"I'm never going to a nursing home."

"I have Medicare."

"I have my child's name on all of my accounts, so the state won't count those funds"

"I'm a veteran, so the VA will take care of all of my long-term care needs."

"My kids will take care of me."

"I don't have enough assets to worry about."

"I put my daughter's name on all of my accounts and she will divide everything equally among all my kids when I die."

"I have my assets in a revocable trust, so they are protected."

"I am leaving everything to my son so he can take care of my child with special needs."

"I don't want to hurt any body's feelings so I just won't do any thing."

"I'll do it LATER."

You've probably used a few that aren't on this list too.  But, guess what?  LATER has come. LATER is TODAY. 

The Elder Law Office of Judith M. Flynn has developed a new workshop to help seniors get their affairs in order.  The Legal Check Up Boot Camp (c) is a free, comprehensive workshop to give seniors all the knowledge they need about Estate and Long-Term Care Planning.

This workshop will empower the attendees to stop procrastinating and finally take control of the decisions they have been avoiding for too long.

This four-hour workshop will be taught in two sessions of two hours each.  Part of the workshop will be interactive to allow attendees to discuss particular problems, concerns and situations.

This workshop will cover:

*what estate planning documents you need in order to achieve your goals and objectives;

* how to properly select Agents, Executors, and Trustees;

* whether you need a Will, a Trust, or both;

* long-term care costs and payment options (Medicare, VA benefits, Long-Term Care Insurance, Private Pay and Medicaid)

* how to protect your home and other assets; 

Each attendee will receive a workbook and will "graduate" from the Boot Camp with a detailed, comprehensive plan of action.

For more details about the Boot Camp or to register, go to:


Tags: PACE, home care, long-term care, asset protection, elder law, Legal Check Up, Legal Documents, Estate Planning, disability planning, Medicare, Community Care, family, Medicaid, Medicaid Home Care, skilled services, rights, Durable Power of Attorney, Living Wills, Health Care Proxy, Last Will & Testament, nursing home, Program of All-Inclusive Care for the Elderly (PAC, Veterans Benefits, Personal Care Assistance Program

Take Advantage of the Circuit Breaker Real Estate Tax Credit

Posted by Judith Flynn on Thu, Dec 29, 2011 @ 23:12 PM

The Massachusetts Department of Revenue (DOR) allows a refundable tax credit for qualifying home owners and non-subsidized renters aged 65 and over, called the "Circuit Breaker."  This tax credit can be significant and is available to seniors (65+) whose property taxes (or 25% of rent) exceed 10% of their annual income and who meet other criteria for the program.


Seniors do not need to owe income taxes in order to file for this credit, but they must file the required state tax form and Schedule CB to calculate the credit.  Call the Massachusetts DOR at 617-887-6367 for more information, or go to to download the necessary forms.  Your accountant should also be able to assist you (or, dare I say, you might consider getting a new accountant)!


BEWARE:  Residents of public housing are not eligible for this tax credit.  If you reside in public housing, the DOR warns you not to fall victim to the scam of unscrupulous tax preparers who want to charge you a fee for their assistance in applying for the credit.

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Tags: asset protection, elder law, Legal Check Up, Elder Financial Abuse, rights, fraud

PEACE of MIND Gift Certificates are the perfect stocking stuffers!!

Posted by Judith Flynn on Mon, Dec 19, 2011 @ 18:12 PM

The holidays are a perfect time to give the gift of Peace of Mind.  PEACE of MIND gift certificates provide you with an easy way to initiate a positive conversation about estate and long-term care planning, and encourage your loved ones to get their affairs in order.

Your loved ones will not be offended by this thoughtful gift that still leaves them in control.  Best of all, it will not need to be returned because it  is the wrong size or color (although it can be returned if they choose not to use it, of course).

Exclusively from the Elder Law Office of Judith M. Flynn, PEACE of MIND Gift Certificates may be purchased in any dollar amount, or for specific services such as:  

* a Legal Check Up;

* Estate Planning Package (including Probate Avoidance and Tax Minimization);

* Asset Protection Package

* Special Needs Planning Package;

* College Student Health Care Proxy/Durable Power of Attorney Package.

Contact us today to learn more at

Tags: long-term care, asset protection, elder law, Legal Check Up, Legal Documents, Estate Planning, disability planning, Medicare, family, Medicaid, Medicaid Home Care, Durable Power of Attorney, Living Wills, Health Care Proxy, Last Will & Testament, nursing home

Give thanks for your health and security, and take steps to protect it for the future.

Posted by Judith Flynn on Fri, Nov 18, 2011 @ 14:11 PM

I've been feeling compelled to once again urge folks to update their basic estate planning documents and take steps to protect themselves and their hard-earned assets because I have seen a significant increase in crisis cases over the past few months.  One panicked daughter could not find out if her mother had been admitted to a psychiatric hospital as she suspected because mom’s Health Care Proxy did not have HIPAA (the health privacy law) release language in it.  The hospital would not speak with the daughter even though she was the named Health Care Agent because the Health Care Proxy is only effective when the principal is deemed incapacitated by a doctor. 

Then I received a call from Margaret to schedule an appointment for her mom (Betty), as her dad (Joe) was hospitalized and would need nursing home care when discharged.  After my meeting with Margaret and Betty, I knew I had to focus on this topic once again.  You see, this family represents the typical readers and, in fact, the typical clients.  Margaret has two siblings, and all of the children have been urging Betty to see an attorney.  They had actually cut my ad out of the SSSN a year ago for mom, who carried it in a folder with some other important information.  Whether Betty was in denial of her husband’s decline, too overwhelmed to deal with the issues, or just resigned that it was too late to do any thing to protect the estate, she didn’t make the call.  Margaret and her siblings did not want to overstep their boundaries and respected Mom’s independence.

So, there we were, faced with crisis planning to ensure that Joe receives quality care while preserving as much of the estate as possible for Betty’s security. There are more options available with advance planning, for sure, but we could still protect most of the estate with crisis strategies. Joe and Betty own four pieces of real estate and have other assets valued at approximately $519,000. Joe may not have more than $2,000 in his name and Betty is only allowed to retain about $109,000. The primary residence is non-countable by MassHealth in this case. Therefore, our plan needed to address the three additional properties and other “excess assets” of about $410,000.  We could protect two of the properties by utilizing exemptions in the MassHealth regulations to convey them out of Joe and Betty’s names.  One property would need to be sold, and we could take all of the excess assets (including the proceeds of the sale of the fourth property) and purchase an annuity that will pay a significant monthly income to Betty.  By converting the countable excess assets to an income stream for the community spouse, we could protect the estate.  Not bad for a crisis plan, right?  Not so fast … while we were able to develop a fantastic plan to protect nearly the entire estate, we can’t implement it!!  Not yet at least.

In order to implement this fantastic plan, we need Joe to sign the Deeds to convey all of the properties out of his name and to transfer all other assets to Betty.  If Joe had executed a comprehensive Durable Power of Attorney that provided Betty with the authority to sign such documents on Joe’s behalf, we could implement the plan using the DPOA.  But he didn’t.  As I tried to explain the problem to Betty and Margaret, Betty reassuringly said, “But he can still sign his name…”  I wish it was that easy, but it is not.  Due to Joe’s dementia, he would not understand what he was signing and I could not, therefore, notarize his signature on the Deeds.  While this plan could have been implemented within a week or two with a proper DPOA, we were instead required to seek the authority of the Court.  We filed a Petition asking the Court to appoint Betty and Margaret as co-guardians of Joe.  Since a guardian (even if it is the spouse) may not convey property of the Ward without Court approval, we must also file a Petition for Authority to Establish an Estate Plan, along with a number of emergency motions to try to get the approval as quickly as possible.  Betty must pay privately for Joe’s nursing home care until we obtain the Court’s approval to do the transfers under the guardianship and obtain MassHealth eligibility.  

I am reminded on a daily basis that the message of the importance of advance planning warrants repeating – over and over and over again.  Don’t be caught carrying an ad a year from now – take steps today to protect yourself.  Update your documents while you can still (knowingly) sign your name! Schedule a Legal Check Up to get started at

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Tags: long-term care, asset protection, elder law, Legal Check Up, Legal Documents, Estate Planning, disability planning, family, lack of capacity, Durable Power of Attorney, Health Care Proxy, Last Will & Testament


Posted by Judith Flynn on Mon, Oct 17, 2011 @ 18:10 PM

We all want to age in place in our own homes, on our own terms -- any place other than a nursing home.  Sometimes situations change quickly, however, and for a number of reasons it just may not be possible to remain safely in the community.  It is at these times of crisis that folks often discover that all the ideas they had about their long-term care security and how they would pay for nursing home care if needed are basically … well, wrong.  There are five major payment sources for nursing home care, each worthy of its own full-length column, but I offer the following brief summary to help dispel some of the myths on this topic. 

The most common misconception I hear from seniors is that Medicare is going to cover all of their nursing home costs.  This simply is NOT true.


Medicare will only cover “skilled” care, and only if all of the following conditions are met:

  • You have Medicare Part A (hospital insurance) and have days left in your benefit period;

  • You have a qualifying hospital stay, which is an inpatient stay of three consecutive days or more, starting with the day of admission and not including the day of discharge. (ALERT:  If you are held for “observation” for part of your hospital stay prior to being admitted, you may not have met the minimum requirement.  This is an issue that should be promptly appealed.)

  • Discharge to the rehabilitation facility either directly or within 30 days;

  • Your doctor orders the services you need for SNF care, which require the skills of professional personnel such as registered nurses, LPNs, phsyical, occupational, and speech therapists, and are furnished by or under the supervision of these skilled personnel;

  • You require the skilled services on a daily basis (5 days per week qualifies).



The availability of 100 days is not, however, a guaranteed coverage period of 100 days.  In fact, it is far from guaranteed with the average period of SNF care covered by Medicare being only 23 days.  You must also qualify according to the clinical criteria set forth by Medicare.  Medicare requires the facility to conduct periodic assessments of your condition and goals to determine whether you will be approved for extended skilled coverage.

Medicare will pay the full cost for days 1-20, and you will be responsible for a significant daily copayment from days 21-100.  Medicare does not pay beyond the 100-day period, unless you have a break in your coverage for at least 60 days.  In that case, with the above conditions met again, you would have a new 100-day period available.

(ALERT:  If you receive a Notice of Medicare Provider Non-Coverage informing you that your Medicare coverage will terminate because you have “reached a plateau,” “are stable,” “custodial care” or not improving, consider filing an immediate appeal.  If you need continued skilled services in order to maintain your present condition, then you are entitled to continued coverage under the Medicare Act and federal law.)


Nursing home care is not automatically available to all veterans enrolled in the VA health plan.  Only the following veterans automatically qualify for unlimited nursing home care:

  • Veterans who are seeking nursing home care for a service-related condition;

  • Veterans with a service-connected disability rating of 70 percent or more;

  • Veterans who have a service-connected disability of 60 percent and are unemployable;

  • A service-connected disability is a disability that the VA has officially ruled was incurred or aggravated while on active duty in the military and in the line of duty. The VA must rule that your illness/condition is directly related to your active military service, and it assigns each disability a rating. The ratings are established by VA regional offices around the country;

  • The VA may provide nursing home care to other veterans if space permits. Veterans with service-connected disabilities receive priority.


The popularity of long-term care insurance is growing, for obvious reasons.  The problem with this payment option, however, is that many people don’t consider purchasing long-term care insurance until they need it.  When they need it, they simply will not qualify for it.  If you have not had a diagnosis that would affect your ability to obtain long-term care insurance, look into it today.  Even if you pay more for it based on your age, the statistics show that your investment will be well worth it down the road.  In addition, there are tax incentives available for purchasing long-term care insurance, and certain qualifying policies can make your home a non-countable asset for Medicaid/MassHealth purposes.  Call my office if you would like a referral to a trusted insurance professional. 


This is the most non-desirable payment option for extended nursing home payment, but most folks do not do adequate pre-planning.  Let me be clear.  Facilities provide care, and facilities need to be paid for their services.  Pre-planning is critical, however, to ensure that you take advantage of laws that allow you to protect your spouse and protect your own quality of care for the future.  Private payment can average from $10,000-$12,000 per month – could you afford to pay this expense for an extended period of time without putting your spouse or your security at risk?  Have you taken the necessary steps to ensure that your security will not be left to chance?


Medicaid is the federal program that is known as MassHealth inMassachusetts.  When you run out of funds to pay for your nursing home care, you can apply for MassHealth coverage.  An individual may only have $2,000 in assets, and a married couple may have a combined $111,560.  There are some assets that are “non-countable” in that limit, such as the marital home, life insurance with a face value of $1,500 or less, a car, life insurance that you can not access or surrender (such as a group or term policy).  There are a myriad of regulations that apply to specific situations, and penalties imposed if you give your funds away within the five years prior to applying for MassHealth.  It is imperative to do advance planning to ensure that you apply the regulations to your particular situation in a manner that will maximize your future security without jeopardizing your eligibility for this important benefit.

This summary is far from comprehensive, but I hope it causes you to reflect on your own situation.  If you would like more information on long-term care payment options or to schedule a Legal Check Up, contact us today.

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Tags: long-term care, asset protection, elder law, Estate Planning, Medicare, Medicaid, termination of benefits, skilled services, improvement standard, rights, nursing home, Veterans Benefits

Asset "Protection" -- Poor Planning Is Worse Than No Planning At All.

Posted by Judith Flynn on Fri, Sep 30, 2011 @ 16:09 PM

The call from the facility to inform me that Howard had passed away triggered a variety of emotions in me, but not for the reasons you might expect. Howard had no family and had not executed a Durable Power of Attorney (DPOA) or Health Care Proxy (HC) to appoint someone to make decisions on his behalf. So, when Howard was suffering from dementia and no longer able to live alone in his apartment, Elder Protective Services asked me to serve as his court-appointed guardian. As Howard’s guardian, I became responsible to make all medical decisions on his behalf, secure appropriate housing and services, and to manage his finances.

I called my colleague Kate to incorporate her geriatric care management services into Howard’s plan. Kate and I moved Howard to an assisted living facility and put services in place to allow him to retain as much independence as possible. Even after the transition to a nursing home became necessary, we maintained companion services to provide Howard with a few hours out of the facility each week.

Kate and I have worked as a team to advocate for all of Howard’s needs, and although his dementia advanced he always knew who we were. In fact, Howard once informed the nursing home staff that he was not happy about something and assured them that “his people” were going to look into it. We were proud to serve as “Howard’s people” and so honored that he realized our role until the day he died. Although we were not “family,” we treated Howard with the respect and dignity we would demand for our own parents.

As my week went on, I was consulted by five siblings regarding their father, Bob, who they believe is being financially exploited by their sibling, Jack. Jack, as agent in the HCP and DPOA, is trying to place Bob in a nursing home contrary to Bob’s wishes and despite the fact that Bob is doing well at home with significant assistance. The reality is that Bob’s care is expensive and funds spent on his care now will reduce his children’s future inheritance. As I listen to this family’s story, it appears that Jack is not acting in his father’s best interest, not upholding his father’s wishes to remain at home and is motivated solely by his own financial gain.

ently, Bob appointed Jack over the objections of all the other children simply because he is the oldest. Jack does not get along with any of his siblings. He has had trouble managing his own finances and filed for bankruptcy in the past. Jack was simply not an appropriate choice to serve as Bob’s agent, and although Bob realized that when he executed his documents, he did not want to hurt Jack’s feelings.

To make matters worse, Bob took steps to protect his assets from the cost of nursing home care by conveying his home and assets to a trust. Yes, you guessed it – Jack is the trustee. Bob is now at risk of being mo
ved to a nursing home against his will, despite the availability of sufficient funds to provide the necessary care in the home.

The cases of Howard and Bob illustrate that poor planning is worse than no pla
nning at all. Make no mistake – the message here is not that planning is not important. It is critical to understand, however, that the primary purpose of planning and protecting assets is to ensure your own future care and security. If your intent is to remain in your home as long as possible, then your planning should reflect that.

You must appoint agents and trustees in a manner that respects your wishes, protects your security and does not leave you vulnerable in the event that relationships go bad in the future.

Howard did no planning at all, but as his Court-appointed guardian I had a duty to use his funds fo
r his benefit and to keep him in the least-restrictive environment as long as possible. In contrast, Bob’s poor planning left him unprotected because in his effort to “protect” assets, he gave up all control over his future security.

If you do not want to find yourself in Bob’s situatio
n, work with an elder law attorney to ensure that your documents include the necessary protective provisions and be willing to make the difficult decisions that are necessary to appoint agents who will hold your wishes and best interests paramount to their own.

Tags: asset protection, elder law, Legal Check Up, Legal Documents, Estate Planning, disability planning, Elder Financial Abuse, lack of capacity, undue influence, Durable Power of Attorney, Health Care Proxy, Last Will & Testament, duress

The Importance of Basic Estate Planning Documents

Posted by Judith Flynn on Mon, Sep 19, 2011 @ 21:09 PM

Most people have conducted some level of estate planning at some point in their lives. Estate planning typically involves a plan for distribution of one’s assets during life and at death. Estate planning for elders is a bit more complicated due to the natural changes that aging brings, and requires consideration of potential changes in mental or physical condition. In addition to a Will, effective planning requires that you appoint someone to act on your behalf if you become incapacitated. This is achieved with a Durable Power of Attorney (for finances) and a Health Care Proxy (for health care).  These documents grant your agent the authority to make decisions on your behalf if you are ever unable to speak for yourself. It is important that you execute these important documents while you are competent to ensure that your wishes are upheld. These documents may also help to avoid the necessity for costly guardianship proceedings in the probate court in the future if you become incapacitated. Following is a brief summary of these essential documents.


A Durable Power of Attorney grants your Agent the authority to act on your behalf in financial and related matters. A Power of Attorney is not sufficient for elder law purposes unless it is Durable, which means it remains effective after the principal becomes incapacitated. The Durable Power of Attorney must be comprehensive, enumerating many specific powers. (If you have a Durable Power of Attorney that is only a page or two long, it is probably not sufficient for many common issues elders face.) There are specific clauses that must be included in order to be effective for many common situations that elders face.  A qualified Elder Law Attorney will be able to discuss these with you and ensure that your Durable Power of Attorney will be honored by third parties (banks, brokerage companies, the Internal Revenue Service, etc.).

The most common Durable Powers of Attorney grant the Agent the right to act immediately, but they can also be drafted to grant “springing” powers to your Agent. A Durable Power of Attorney with springing powers will grant your Agent authority to act only after one or two physicians certify your inability to act on your own behalf. Unfortunately, third parties are often more cautious in dealing with documents with springing powers, so your Agent may have difficulty acting on your behalf with a springing Durable Power of Attorney.

It is important that you trust your Agent completely, and you should understand that your Agent has a legal duty to act in your best interests. If you are uncomfortable with granting immediate authority, however, there is another option. You may execute a Durable Power of Attorney that grants your Agent immediate powers to act on your behalf, but have your attorney hold the documents in “escrow” until your Agent presents proof of your incapacity. This avoids the heightened scrutiny from banks and other institutions, but affords you the added comfort and security you desire.


A Health Care Proxy grants your Agent authority to make health care decisions on your behalf, but only after you have been deemed incapable of making or communicating decisions for yourself. It is a springing power by definition. It is important that you discuss your wishes with your Agent so that they may communicate your wishes if you are not able to. Unlike a Durable Power of Attorney, your health care Agent should make decisions that you would make if you were able, rather than decisions that he or she thinks are best. Your Agent can only fulfill this duty, however, if you take the time to inform them of your wishes.

In addition, because your Health Care Proxy is a “springing” document, your document should include a clause granting your Agent immediate authority to act on your behalf under HIPAA (Health Insurance Portability and Accountability Act). HIPAA was enacted to give individuals greater protection over their medical records, but there may be circumstances in which you need your Agent to assist you regarding your medical records before your Health Care Proxy springs into effect.


Although Living Wills are not enforceable in Massachusetts, it is still recommended that you execute one as a written expression of your wishes regarding artificial feeding or respiration, invasive surgery, etc. If there is ever a dispute about your care in the future, the Court can rely on your Living Will as evidence of what you would want.  (Remember the recent case of Terry Schiavo … her husband and her parents disagreed as to whether she would want to be artificially sustained. If she had executed a Living Will, the court could have relied on it to determine what she would have wanted.)


Your Will designates who the beneficiaries of your estate will be. If you and your spouse have “Sweetheart” Wills (each of you leaves everything to your beloved spouse …), consider drafting new Wills which could protect your assets if one of you requires nursing home care. There are strategies you can employ that will ensure that your spouse benefits from your estate if you predecease him or her, without leaving your estate vulnerable to the cost of nursing home care. In addition, if you have a disabled child you will want to make specific provisions in your Will to provide for that child without causing a disqualification from any public benefits he or she is entitled to.

So, dust off that old estate plan and give it a fresh look since your situation has probably changed significantly since you last reviewed it. If you have never done any estate planning documents, now is the time. Take greater control of your future -- call us at 781-681-6638 to schedule a Legal Check Up.

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Tags: asset protection, elder law, Legal Check Up, Legal Documents, Estate Planning, disability planning, lack of capacity, Durable Power of Attorney, Living Wills, Health Care Proxy, Last Will & Testament

PACE - Program of All-Inclusive Care for the Elderly

Posted by Judith Flynn on Thu, Sep 08, 2011 @ 19:09 PM

Long-term care planning is a significant part of most elder law practices.  While the ideal clients seek counsel long before there is a crisis, the usual clients do not.  It is in these crisis situations that clients benefit most from an elder law attorney's knowledge of the resources available in their communities and an understanding of the medical and financial criteria for eligibility.
PACE, the Program for All-Inclusive Care for the Elderly, is a national comprehensive health program created to help elders remain at home as long as possible.  While PACE is a valuable resource for many elders, it remains a fuzzy concept for many attorneys and is, thereby, under utilized.

Unfortunately, PACE is not available in all cities and towns, but is available in:
Allston, Arlington, Avon, Beverly, Boston, Braintree, Brighton, Brookline, Cambridge, Canton, Charlestown, Chelsea,  Danvers, Dedham, Dorchester, East Boston, Essex, Everett,  Gloucester,  Hamilton,Hudson, Hyde Park, Ipswich, Kenmore, Lynn, Lynnfield, Magnolia, Malden, Manchester, Marblehead, Marlboro, Mattapan, Medford,  Middleton, Milton, Nahant, Norwood, Peabody, Quincy, Randolph, Revere, Roslindale, Rockport, Roxbury, Salem, Saugus, Sharon, Somerville, South Boston, South Hamilton, Stoughton, Swampscott, Topsfield, Wakefield, Wenham, West Roxbury, Weymouth, Winthrop, all towns in WorcesterCounty,  

In order to be eligible for PACE, applicants must be 55 years of age or older, live in a PACE service area as outlined above, and must be certified by the state as eligible for nursing home care but able to safely remain in the community with the additional supports PACE offers.  Members must also agree to receive all health services exclusively through the Elder Service Plan.  While many elders are initially hesitant to give up their primary care physicians or other medical professionals, it is the interdisciplinary team model of PACE that allows each member to maximize his or her potential to remain in the community and ensures that nobody falls through the cracks.

PACE is jointly funded by Medicaid (2/3) and Medicare (1/3) in a capitated system.  In other words, Medicaid and Medicare each pay a set rate per member per month.  Medicaid presently pays $3,497 per member per month, with the Medicare rate dependent on the diagnosis codes of each member.  Each PACE program must offer a number of Core Services, and may offer elective services based on the various needs of their members.  This flexibility allows each program to customize individualized care plans designed to help each member maximize his or her potential.

Interdisciplinary teams of doctors, nurses, social workers, therapists, nutritionists, and other medical staff work together to provide primary medical care, home health, adult day health (recreation), rehabilitation services, transportation, medications, podiatry, optometry, dental, social services, and more.  While the majority of PACE services are provided at an adult day center to encourage socialization and activity, services are provided in the home when appropriate.  Some PACE programs offer residence in certain Assisted Living Facilities. PACE members never pay more than their income for a PACE apartment in an assisted living facility.  If nursing home care becomes necessary, it is paid for by PACE and PACE continues to coordinate the member’s care, so long as the member does not disenroll from the PACE program.

PACE accepts Medicare, Medicaid, and private payment.  For married couples, only the income and assets of the applicant are countable.  For members with monthly income of $2,022 or less per month, there is no monthly spenddown and they can keep the entire $2,022.  For members who have income over $2,022, there is a monthly spenddown to $542.  Members with monthly income over $4,039 (which represents the MassHealth amount of $3,497 plus the deductible of $542) would pay privately, while members with income below $4,039 would apply for MassHealth in order to keep the $542 monthly.   Private pay members pay only the portion that Medicaid would pay, or $3,497 per month.

The most significant reason that PACE is appealing is that its primary goal is to provide each member with the individual supports needed to remain in the community as long as possible.  Another benefit to consider is that PACE is covered by Community MassHealth, under which transfers of assets are presently not penalized.  Therefore, for people who have not done prior planning who are suddenly faced with the need for long-term care services, the option of joining PACE should be explored for 1) quality of life issues and 2) additional planning options.  In addition, the application process for Community MassHealth/PACE is far less burdensome than the long-term care MassHealth application, requiring only a few months of financial statements to verify assets (as compared with up to five years of verifications for long-term care MassHealth).  Members are free to disenroll from PACE at any time. PACE is not for every body, but if you are fortunate enough to live in a PACE service area, this is an option that warrants consideration. 

Call my office at 781-681-6638 if you are interested in exploring the PACE program to help you remain safely in your home.

Tags: PACE, home care, long-term care, asset protection, elder law