Another Blow for the Elderly/Poor

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Specializes in Case Management, Home Health, UM.

Read this. I hope to God I am dead and buried, by the time I need 24-7 nursing care :angryfire

Rule change could force some out of nursing homes

By ANDY MILLER

The Atlanta Journal-Constitution

Published on: 07/31/04

Anderson Ray, 76, is sitting in his favorite chair-a recliner brought from home-as his wife and son enter his room in a Conyers nursing home.

"Hey Darlin'," says his wife, Sarah. "Whatcha up to?"

Sarah Ray visits her husband, Anderson, at a nursing home in Conyers. The Rays have signed trust documents to preserve his Medicaid coverage, in response to the state's plan to eliminate its 'medically needy' program.

They have been married 58 years, and the visit comes on her 75th birthday. Anderson Ray, who has Alzheimer's, doesn't appear to recognize them. He mutters few responses to their questions, spending most of their visit staring into space.

Minutes earlier, Sarah and son Chris completed paperwork that will help Anderson remain in his favorite chair, in the facility close to their home. They signed documents creating a trust that will preserve Medicaid coverage for his nursing home care.

Across Georgia, families of hundreds of nursing home residents, aided by attorneys, are scrambling to set up such trusts so their loved ones can keep Medicaid benefits-and avoid a possible discharge from the facility into a medical unknown.

The legal flurry comes as a response to a state rule change eliminating the "medically needy" program, which allows an estimated 1,500 people to have Medicaid nursing home coverage. These individuals earn too much to qualify for regular Medicaid but not enough to afford a nursing home's private rates.

But patient advocates say an undetermined number of the medically needy patients in nursing homes are mentally incompetent and lack a legal guardian or proper power of attorney. That puts them in jeopardy of not getting a trust in place before the Sept. 30 deadline. The Georgia Nursing Home Association estimates 100 to 300 patients are in this predicament, a tiny fraction of the 39,000 nursing home residents in the state.

Patient advocates fear that these patients will be moved from nursing homes into situations where they won't receive the medical care they need.

The state estimated it will save $9.7 million by ending the medically needy coverage. But the Department of Community Health, which runs Medicaid in Georgia, recently conceded the state did not factor the trusts into that estimate.

Currently, the agency does not provide a savings estimate. Medicaid will pay the same amount for an individual with a trust as it does under the medically needy program, legal experts say.

"I don't think they're going to save anything, because of the trusts and because many of those [vacated] beds will be filled by people who will be on Medicaid," says Fred Watson, president of the Georgia Nursing Home Association. The financial impact of the rule change on the industry will be minimal, he said.

Future savings cited

Community Health acknowledges that trusts will reduce immediate gains for the state but says there will be future savings because people will consider other financing options for long-term care.

For now, medically needy patients who don't have trusts may end up in personal care homes, where there's no nursing oversight, says Becky Kurtz, the state's long-term care ombudsman. A personal care home, under state regulations, can't perform medical duties, such as changing bandages and dressings, and administering medication, Kurtz says. Personal care homes generally are less expensive than nursing homes.

"I'm very concerned that there are going to be individuals with no one to help them, and no options to get the care they need," Kurtz says. The state, she says, has no plan to help the medically needy with proper placement.

For those who fall through the cracks and don't set up trusts, the nursing home will have the responsibility to make an appropriate placement, Kurtz says.

"The nursing home is not likely to send them to a place where their needs can't be met," says Watson of the Nursing Home Association.

A spokeswoman for Gov. Sonny Perdue says various state agencies are working to identify those incapable of making decisions and without legal guardians, and to find legal advisers to help them.

Last month, with Perdue's recommendation, a state agency delayed the benefit cutoff date from July 31 to Sept. 30, giving patients' families more time to establish trusts or find alternative care.

Despite the delay, family members still express anger, fear and confusion about the rule change, caused by the state's budget crunch.

When the Ray family received a state letter about the program cutoff, "we were shocked and scared," said Chris Ray. "We didn't know what to do."

Sarah Ray, who has had quadruple-bypass surgery and walks with help of a cane, says eliminating the medically needy program "makes no sense to me. I don't understand any of it."

'Shocked and outraged'

About 30 states operate medically needy programs for nursing homes. The elimination of Georgia's program came as one of several health benefits cuts recommended by Perdue and passed by the General Assembly.

"AARP Georgia is shocked and outraged at the governor's attempts to balance the budget on the backs of the state's oldest, most infirm and economically disadvantaged residents," said Cas Robinson, president of the group.

Some Democrats have called for Perdue to reinstate the medically needy benefit.

"We think more than one-third of the people have no family," says Lt. Gov. Mark Taylor. "Without a very involved, very informed family member to manage a trust, it is going to be an unacceptable option."

Taylor says the General Assembly, when it convenes in January, will restore the medically needy funding. In the meantime, he says, Perdue should intervene to save the program.

"If we have a bone of decency in our bodies, we will restore these funds," Taylor says.

Still, Perdue has control of the budget process, with line-item veto power.

Perdue spokeswoman Loretta Lepore says the state doesn't have the money to restore the medically needy eligibility.

"Any excess money the state has in its reserves currently is committed to education," she says.

Medicaid, the federal-state program for low-income and disabled people, covers 1.4 million Georgians.

But consumer advocate Martha Eaves says the state "won't save one red cent" on people who set up trusts.

"The people with Alzheimer's who have no survivors-what's going to happen to them?" says Eaves, the legislative chairman of the Georgia Council on Aging. "These people wouldn't be in nursing homes if they didn't need to be."

Families pursuing a trust, meanwhile, are finding the process isn't easy to navigate.

Under rules for a qualified income trust, known as a Miller trust, some or all of a nursing home resident's income is diverted to that account. That shift brings their income level under $1,692 per month, which would qualify them for Medicaid. The trust and other income pay part of the nursing home bill, and Medicaid pays the rest.

Families creating trusts establish bank accounts to administer it. Trustees write monthly checks to the nursing home.

"There are some people, because of their age, who will have trouble administering these trusts, and the [nursing home resident] will lose eligibility," warns David McGuffey, a Dalton elder-law attorney.

Practices vary by area

Georgia Legal Services, which estimates it will help 600 medically needy by establishing trusts or making lawyer referrals, says the practices to establish guardianship and trusts vary by area of the state. Even some banks don't know how to handle a trust account, says the nonprofit organization, which provides legal assistance in civil matters to low-income residents.

While Legal Services isn't charging clients for trusts, the fees for private attorneys appear to range from $500 to $4,000, Kurtz says.

Billie Cantrell and her husband, James, are struggling to get a trust set up in time for her mother, Catherine Allen, 95, who's in a Pelham nursing home with Alzheimer's.

They have a hearing set this month with a probate judge to gain guardianship. But the Cantrells have been advised they also need permission from a Superior Court judge to create a trust.

The Cantrells themselves have had medical problems recently. "It's just been pure hell," Billie Cantrell says. "I've gone through every emotion in the book."

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Specializes in critical care; community health; psych.

Thanks for posting the article. It is scary. I'm looking into LTC insurance.

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Disgusting.

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I'm looking into that insurance as well. I know darn well when it's time for me to retire the government sure isn't going to help me out. They aren't investing what we're paying in taxes for the future, they never did. The government, no matter what party it is, is all about spending what they get.

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I'm looking into that insurance as well. I know darn well when it's time for me to retire the government sure isn't going to help me out. They aren't investing what we're paying in taxes for the future, they never did. The government, no matter what party it is, is all about spending what they get.

Why do you deserve anything ? You just worked your entire life . you have nothing more to contribute :angryfire

GRRRRRRr I totally agree with you.

I actually didn't know there IS LTC insurance, but it sounds like a good idea.

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ok, help me out here please.

i don't understand what the trust is? is it an acct. where people can put their money and be eligible for medicaid?

all i know is that the social worker used to tell families that in order to be medicaid eligible (and gain admission to the facility), they would have to spend away their assets.....which is also unconscionable.

and how much do you think ltc insurance will be? i am thinking astronomical.

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ok, help me out here please.

i don't understand what the trust is? is it an acct. where people can put their money and be eligible for medicaid?

all i know is that the social worker used to tell families that in order to be medicaid eligible (and gain admission to the facility), they would have to spend away their assets.....which is also unconscionable.

and how much do you think ltc insurance will be? i am thinking astronomical.

I tried to buy LTC insurance a few years ago but had to quit cause I couldn't afford it. It was around $1200.00 a year.

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In the event family can't be your long term insurance policy, (I know mine is)

guess it's best to pay as we go along....check the policies... they are tricky.

And don't forget disability insurance. That is a biggie to have. Perhaps I say this as I take care of quads. Some have it, some don't. BIG difference.

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Addendum: Didn't mean my family has bucks, hardly. But we are close and we take care of our own.

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Read this. I hope to God I am dead and buried, by the time I need 24-7 nursing care :angryfire

Rule change could force some out of nursing homes

By ANDY MILLER

The Atlanta Journal-Constitution

Published on: 07/31/04

Anderson Ray, 76, is sitting in his favorite chair-a recliner brought from home-as his wife and son enter his room in a Conyers nursing home.

"Hey Darlin'," says his wife, Sarah. "Whatcha up to?"

Sarah Ray visits her husband, Anderson, at a nursing home in Conyers. The Rays have signed trust documents to preserve his Medicaid coverage, in response to the state's plan to eliminate its 'medically needy' program.

They have been married 58 years, and the visit comes on her 75th birthday. Anderson Ray, who has Alzheimer's, doesn't appear to recognize them. He mutters few responses to their questions, spending most of their visit staring into space.

Minutes earlier, Sarah and son Chris completed paperwork that will help Anderson remain in his favorite chair, in the facility close to their home. They signed documents creating a trust that will preserve Medicaid coverage for his nursing home care.

Across Georgia, families of hundreds of nursing home residents, aided by attorneys, are scrambling to set up such trusts so their loved ones can keep Medicaid benefits-and avoid a possible discharge from the facility into a medical unknown.

The legal flurry comes as a response to a state rule change eliminating the "medically needy" program, which allows an estimated 1,500 people to have Medicaid nursing home coverage. These individuals earn too much to qualify for regular Medicaid but not enough to afford a nursing home's private rates.

But patient advocates say an undetermined number of the medically needy patients in nursing homes are mentally incompetent and lack a legal guardian or proper power of attorney. That puts them in jeopardy of not getting a trust in place before the Sept. 30 deadline. The Georgia Nursing Home Association estimates 100 to 300 patients are in this predicament, a tiny fraction of the 39,000 nursing home residents in the state.

Patient advocates fear that these patients will be moved from nursing homes into situations where they won't receive the medical care they need.

The state estimated it will save $9.7 million by ending the medically needy coverage. But the Department of Community Health, which runs Medicaid in Georgia, recently conceded the state did not factor the trusts into that estimate.

Currently, the agency does not provide a savings estimate. Medicaid will pay the same amount for an individual with a trust as it does under the medically needy program, legal experts say.

"I don't think they're going to save anything, because of the trusts and because many of those [vacated] beds will be filled by people who will be on Medicaid," says Fred Watson, president of the Georgia Nursing Home Association. The financial impact of the rule change on the industry will be minimal, he said.

Future savings cited

Community Health acknowledges that trusts will reduce immediate gains for the state but says there will be future savings because people will consider other financing options for long-term care.

For now, medically needy patients who don't have trusts may end up in personal care homes, where there's no nursing oversight, says Becky Kurtz, the state's long-term care ombudsman. A personal care home, under state regulations, can't perform medical duties, such as changing bandages and dressings, and administering medication, Kurtz says. Personal care homes generally are less expensive than nursing homes.

"I'm very concerned that there are going to be individuals with no one to help them, and no options to get the care they need," Kurtz says. The state, she says, has no plan to help the medically needy with proper placement.

For those who fall through the cracks and don't set up trusts, the nursing home will have the responsibility to make an appropriate placement, Kurtz says.

"The nursing home is not likely to send them to a place where their needs can't be met," says Watson of the Nursing Home Association.

A spokeswoman for Gov. Sonny Perdue says various state agencies are working to identify those incapable of making decisions and without legal guardians, and to find legal advisers to help them.

Last month, with Perdue's recommendation, a state agency delayed the benefit cutoff date from July 31 to Sept. 30, giving patients' families more time to establish trusts or find alternative care.

Despite the delay, family members still express anger, fear and confusion about the rule change, caused by the state's budget crunch.

When the Ray family received a state letter about the program cutoff, "we were shocked and scared," said Chris Ray. "We didn't know what to do."

Sarah Ray, who has had quadruple-bypass surgery and walks with help of a cane, says eliminating the medically needy program "makes no sense to me. I don't understand any of it."

'Shocked and outraged'

About 30 states operate medically needy programs for nursing homes. The elimination of Georgia's program came as one of several health benefits cuts recommended by Perdue and passed by the General Assembly.

"AARP Georgia is shocked and outraged at the governor's attempts to balance the budget on the backs of the state's oldest, most infirm and economically disadvantaged residents," said Cas Robinson, president of the group.

Some Democrats have called for Perdue to reinstate the medically needy benefit.

"We think more than one-third of the people have no family," says Lt. Gov. Mark Taylor. "Without a very involved, very informed family member to manage a trust, it is going to be an unacceptable option."

Taylor says the General Assembly, when it convenes in January, will restore the medically needy funding. In the meantime, he says, Perdue should intervene to save the program.

"If we have a bone of decency in our bodies, we will restore these funds," Taylor says.

Still, Perdue has control of the budget process, with line-item veto power.

Perdue spokeswoman Loretta Lepore says the state doesn't have the money to restore the medically needy eligibility.

"Any excess money the state has in its reserves currently is committed to education," she says.

Medicaid, the federal-state program for low-income and disabled people, covers 1.4 million Georgians.

But consumer advocate Martha Eaves says the state "won't save one red cent" on people who set up trusts.

"The people with Alzheimer's who have no survivors-what's going to happen to them?" says Eaves, the legislative chairman of the Georgia Council on Aging. "These people wouldn't be in nursing homes if they didn't need to be."

Families pursuing a trust, meanwhile, are finding the process isn't easy to navigate.

Under rules for a qualified income trust, known as a Miller trust, some or all of a nursing home resident's income is diverted to that account. That shift brings their income level under $1,692 per month, which would qualify them for Medicaid. The trust and other income pay part of the nursing home bill, and Medicaid pays the rest.

Families creating trusts establish bank accounts to administer it. Trustees write monthly checks to the nursing home.

"There are some people, because of their age, who will have trouble administering these trusts, and the [nursing home resident] will lose eligibility," warns David McGuffey, a Dalton elder-law attorney.

Practices vary by area

Georgia Legal Services, which estimates it will help 600 medically needy by establishing trusts or making lawyer referrals, says the practices to establish guardianship and trusts vary by area of the state. Even some banks don't know how to handle a trust account, says the nonprofit organization, which provides legal assistance in civil matters to low-income residents.

While Legal Services isn't charging clients for trusts, the fees for private attorneys appear to range from $500 to $4,000, Kurtz says.

Billie Cantrell and her husband, James, are struggling to get a trust set up in time for her mother, Catherine Allen, 95, who's in a Pelham nursing home with Alzheimer's.

They have a hearing set this month with a probate judge to gain guardianship. But the Cantrells have been advised they also need permission from a Superior Court judge to create a trust.

The Cantrells themselves have had medical problems recently. "It's just been pure hell," Billie Cantrell says. "I've gone through every emotion in the book."

HI-They have been pulling this in Forida for the last few years-the Nursing Home Industry has an extremely powerful and well financed Lobby and they are trying to pass new laws all the time-usually not benefiting patient's.I suspect it is the same in Ga. As we know staffing is dismal at most nursing home-the operators/owners cry poor but leave the facility in a new $65000 Mercedes. They claim no $$ for aides but lots for the new Mercedes. It is a sorry state of affairs-and I share your 1st option! Watch the very fine print on those long term care policies; Lots of exclusions and surprises Folks! As I travel out of the country often-a 5 star nursing home in Bogota where my dentst lives, cost about $500/monthly-and top notch!!Maybe my option when I need it-Mike:coollook:
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