A Look Inside the Firm
by Jana Hennessey
When I began my work ten years ago at KC Elder Law, my knowledge of elder law was very limited. I thought it would be a promising area of law to explore, due to the increasing aging population and longer life expectancy. What I didn’t realize is the great need for these services and what a rewarding career it would be.
What We Do
Our firm specializes in Medicaid and estate planning and we practice in both Kansas and Missouri. Our goal is to help people protect themselves, their family, and their assets as much as possible. The services we provide involve three stages which we refer to as the Elder Care Journey. Stage One planning is for healthy seniors wanting to “get their ducks in a row” to make sure their estate planning is properly in place. Stage Two planning is for seniors who have memory or mobility issues. They may be living independently, with a caregiver at home, or in assisted living facility. Stage Three planning is for those who are in need of immediate nursing home care or for those who have already been placed in a long-term care facility.
Stage One usually consists of what one may think of as traditional estate planning, including powers of attorney, wills and trusts. Our documents are more comprehensive than general estate planning documents, to include important provisions that allow the fiduciaries of the client to do gifting and Medicaid planning on behalf of the client should he or she become incompetent. Stage Two involves more in-depth planning, which may consist of gifting or transferring the client’s assets, or setting up a care contract. Stage Three may also involve gifts or transfers, and includes preparing and filing a Medicaid application on behalf of the client to qualify him or her for benefits
How Does One Pay For Nursing Home Care?
For many seniors, paying for nursing home care is one of their greatest concerns. There are basically four ways you can pay for care:
- Pay with your own funds
- Long term care insurance
- Medicare
- Medicaid
Few people can afford to pay for nursing home care with their own funds. Long term care insurance can be a good investment but it has become popular only in recent years, and many of our clients either cannot afford it or have pre-existing health conditions that make them uninsurable. Therefore, most people rely on Medicare and Medicaid
Medicare vs. Medicaid
What’s the difference between Medicare and Medicaid?
Medicare is a federally funded health insurance program primarily designed for those age 65 and over, however it has limited benefits. If you are hospitalized for at least three days, and then you need skilled nursing (for rehabilitation), Medicare will cover these costs, but for a limited length of time.
The maximum stay that Medicare will cover in a skilled nursing facility is 100 days. The first 20 days are paid in full by Medicare and then the remaining 80 days are subject to a co-pay. Some individuals have supplemental insurance that will cover the cost of the co-pay. Medicare will pay as long as the patient progresses in his or her rehabilitation. If the patient is no longer progressing, then Medicare will no longer pay. It has been our experience at the firm that many of our clients fall short of reaching the maximum benefit of 100 days.
Medicaid is a health program jointly funded by the federal and state governments, and administered by each state. Unlike Medicare, which covers skilled nursing for a short period of time, Medicaid will cover the cost of long term care, if you meet certain qualifications. Although each state follows the same basic framework of the program, qualifications vary from state to state.
To qualify for Medicaid, a nursing home resident in Kansas cannot have more than $2,000 of countable assets; in Missouri, the limit is $5,000. Again, the laws vary from state to state.
Certain assets are exempt from Medicaid. These exempt assets typically include your house, a car, a funeral plan, life insurance, and household goods. Generally, all other assets are countable.
If you are married, then a provision called Division of Assets is applied. The couple gathers all of their countable assets for review. They are allowed the same exempt assets as a single person. The value of the total countable assets are then divided by two. The nursing home spouse must spend his or her half down to the Medicaid limit (i.e., $2,000 in Kansas, $5,000 in Missouri). The at-home spouse can keep his or her half, up to a maximum of just over $128,640.
There are many more provisions, exemptions, and exceptions to the Medicaid rules that can affect an individual’s or a couple’s spend down, and these are constantly changing. The most drastic change was the implementation of the Deficit Reduction Act of 2005 (DRA) which took effect February 8, 2006. This law significantly changed the Medicaid rules regarding the treatment of gifts and transfers of assets. This negated many of the planning techniques that worked in the past and elder law attorneys had to come up with new strategies. Because of this law, it is even more important for seniors to plan early in anticipation of their long term care needs.
Paralegals and Their Role
Our five-attorney firm has four paralegals: two of us draft the estate planning and real estate documents, and two of us are responsible for preparing and submitting the Medicaid applications. None of us work specifically with any one attorney, and we often share files with other paralegals, depending upon the stage of planning.
Many of our document signing appointments are handled by paralegals, which gives us the opportunity to meet the clients in person. These meetings may occur in our office, the client’s home, a hospital, or a nursing home.
One common task that we all do as paralegals is to conduct phone interviews with prospective clients. When a person calls our office to make an appointment, we ask him or her a series of questions to get information regarding the individual’s health, living situation, family background, estate planning, and assets. Since elder law encompasses a wide range of topics, sometimes the need of the client is outside the scope of our practice and the services we provide. If that is the case, then we provide that person with resources or referrals so that they can get the help or guidance they need. Otherwise, the information is passed on to an attorney who reviews the facts, then sets an appointment for the initial consultation.
Other paralegal duties include providing assistance with funding of trusts and asset transfers, and answering client questions.
What Does it Take?
What kinds of qualities are important to be a paralegal in the field of elder law? As with any other law practice, communication skills, writing skills, and attention to detail are imperative. You must also be able to deal with a range of emotions from clients. The issues that elders face can be overwhelming, stressful, and scary for them. Client situations can also change quickly, so you must be able to think on your feet and adapt accordingly.
While the elder law environment may present some additional challenges, it’s well worth it to know that you’ve made a difference in the lives of others and given them hope during a difficult time.
For more information:
The difference between elder care and estate planning attorneys
The Consumer's Guide to Medicaid Planning and Division of Assets