Does Your Caregiver Have Sticky Fingers?

You need someone to help you as you age., or perhaps you have an ailing parent that needs some help around their home.  You don’t want them to go into a nursing home, and your solution is to bring in an aide to help out. recently published an article  entitled “5 Signs a Caregiver is Stealing From You” that offers some early warning signs to watch out for.

It’s frightening to be so vulnerable as we get older. The solution is to be alert, ensure family members visit often and unexpectedly and beware of these potential pitfalls:

Receipts that don’t add up,  frequent cell phone use on the job, becoming emotionally involved with or dependent upon the caregiver, bids for sympathy, and missing work on Mondays are some of the most important early warning signs to watch for.

Spousal Refusal In New York — Just Say No?

First, the good news: Despite another attempt by the New York governor to eliminate spousal refusal from this year’s budget for community-based care, the budget was passed by the legislature this week without this change.

What Is Spousal Refusal, And Why Is It Important?

Let’s say your dad is in a nursing home, but your mom is well and lives at home. Medicaid will only pay for your dad’s nursing home bills if he qualifies as poor — not having enough income to privately pay for the nursing home. The problem is that Medicaid counts both your mom and dad’s income in deciding if he qualifies for assistance.

They allow your mom a certain amount of income, but anything more than that and your parents lose the Medicaid assistance.

Especially here on Long Island, this often leaves your mom — known as the “well spouse” — with not enough income or assets to cover her basic housing and other needs.

One of the techniques attorneys use to protect people like your mom is file a document with the Medicaid application that your mom refuses to contribute income and assets to your dad’s long term care: so-called “spousal refusal.” Medicaid cannot legally be denied to the spouse in need. It’s sort of like getting divorced for tax reasons — without the divorce.

The Fly in the Ointment

For the past few years, the Department of Social Services (DSS) has been threatening lawsuits to recover the cost of care from the refusing spouse. Often, DSS does not follow through, or we can come to a settlement for much less than the full amount, and even so, DSS only seeks to recover the Medicaid rate, not the private pay rate, potentially saving thousands of dollars each month.

Finally, the Bad News

Even though the legislature did not eliminate spousal refusal in this year’s budget, or last year’s, New York’s budget is under pressure. Spousal refusal is only allowed in three states, and I suspect the Governor and other legislative forces will keep trying to get this passed.

Plan for the Elimination of Spousal Refusal

While spousal refusal is an excellent tool to use right now, when my clients are in a crisis and there is an immediate need to apply for Medicaid to get help, it’s clear that this strategy has a limited shelf life. You can avoid this problem by meeting with an elder law attorney now, and planning for the future. As the old saying goes: hope for the best, and plan for the worst.

It’s Not Monopoly Money, It’s Your Hard Earned Wealth

A recent article in Forbes highlights a study that half of all people lose all their wealth after just 6 months in a nursing home.

I’m going to repeat that:  Half of all residents in a nursing home lose ALL their wealth, including their home equity, after just 6 months in a nursing home.

As a middle class Long Island resident, that is one of the most frightening statistics I have heard in a long time.  The people I know– my friends, clients and elderly neighbors, worked hard and saved hard all their lives to accumulate what they have.  They gave up vacations, manicures and Starbucks in order to save money they thought they might need when they retired.  To think it could all be wiped out in six months is a devastating thought.

We know that the cost of a nursing home is approximately $12,000- $15,000 each month on Long Island.  Many of the people surveyed had less wealth than average people their age before they entered the nursing home.  That can easily be explained in two ways.  Before people enter nursing homes, they will often spend much of their money on care–medication, doctors, home health care aides.  Even a few hours per day of hiring an aide can quickly wipe out savings.

Or it can be explained by good planning.  Perhaps the people in the study had ensured that much of their hard earned assets were safe from the bite of those huge monthly nursing home bills.  Planning for long term care is essential and must be done prior to you or your spouse becoming ill.

Medicaid: The Middle Class Safety Net

As this article in today’s New York Times points out, Medicare is getting the bulk of the attention in this election campaign, while more attention needs to be focused on the problem of Medicaid.

“Medicaid has long conjured up images of inner-city clinics jammed with poor families. Its far less-visible role is as the only safety net for millions of middle-class people whose needs for long-term care, at home or in a nursing home, outlast their resources.”

As Robyn Grant,  the director of public policy and advocacy for the National Consumer Voice for Quality Long Term Care points out “More than $80,000 a year on average for a nursing home– who can sustain that?”  On Long Island that cost is closer to $150,000 each year on average.  She continues to say “We’re forced most of us to go onto Medicaid.” People don’t realize this.

The article also suggests that some lawyers specialize in setting up trusts that shelter certain assets, and that the government has closed some loopholes that allow these trusts.

Sheltering assets through trusts is still a viable option.  The loophole is in the length of time needed to fully protect your assets.  Currently, that length of time is 5 years before your home and other liquid assets can be protected.

When Siblings Don’t Agree About Mom and Dad’s Care

Remember the fights you used to have with your brother over who got the last Ring Ding?  (Okay, maybe that was only me).


I’m an independent woman, an elder lawyer, no less.  Yet, when it comes to making decisions about my Mom, I turn first to my brother.  After all, my Mom is his Mom, and I don’t want to totally take charge, although it would be easy to do so. But mostly I like having someone to share the burden with.  Although I help families make decisions about their aging parents, when it comes to mine, I lean on family.


But what happens when you never got over that sibling rivalry?  Or when you honestly just disagree about how your parents should be cared for?


This article offers one solution—elder mediation.  A mediator may well be able to help siblings struggling with how to care for elderly parents and how to pay for that care.  Many elder lawyers are equipped to help work through solutions, but there are mediators in New York who specialize in elder problems.


Does Size Matter?

Does the size of your brain predict the likelihood of developing Alzheimer’s disease?  One study released December 2011 in Neurology, the medical journal of the American Academy of Neurology, finds that smaller brain size has a high correlation with the risk of developing Alzheimer’s.    Technically, the researchers found that the thickness of regions of the cortex known to be vulnerable to Alzheimer’s disease.  The study was conducted among people in their mid-seventies who have not shown signs of memory loss.


Predicting who may be at a higher risk for the disease is important, as early detection may be an important step to slowing down or stopping the progression of memory loss and cognitive function.


Another marker, according to the press release, is abnormal levels of protein in cerebrospinal fluid.  For more information on this study, click here.



Alzheimer’s or a Vitamin Deficiency?

According to an article in today’s New York Times by health writer Jane Brody, below normal levels of B-12 can sometimes mimic the signs of Alzheimer’s Disease.


According to Brody, Vitamin B-12 is absorbed less readily as we age, and a deficiency can cause symptoms of memory loss and confusion–the same symptoms as an early Alzheimer’s diagnosis.


A study in the American Journal of Clinical Nutrition found that supplementing people without deficiencies of B-12 did not improve cognitive impairment with normal levels of the vitamin, but did improve cognition among women with a low intake of B vitamins.


Although I’m not a doctor, it seems to me that testing for Vitamin B-12 deficiency in older adults should be a routine procedure.

There’s a Criminal Employed in Your Nursing Home

The Inspector General of the U.S. Department of Health and Human Services issued a report this past March, analyzing 35,000 nursing home employee records of nursing homes against criminal records maintained by the Federal Bureau of Investigations (FBI).


92% of nursing homes employ one or more people with a criminal conviction.  Nearly half of nursing homes employed people with five or more criminal convictions.  Although most of the convictions took place prior to employment, 16% of the convictions were for offenses after being hired.


Although nursing home facilities are prohibited from hiring or employing persons found guilty of abusing, neglecting or mistreating residents, apparently this prohibition does not extend to workers who had previously been found guilty of crimes against property.


The NY Times reported that although most of the criminal convictions were for activities such as burglary or shoplifting, some  were for personal crimes such as assault.


Residents in nursing homes are a vulnerable section of our population.  These residents are often left alone with aides and supervision is poor.  Nursing homes must do a better job in screening employees.



The Survey Says: NY a Winner in the High Cost of Long Term Care

In this survey, New York “only” comes in fifth in the country on the list of most expensive annual cost for a private room at a nursing home.  The survey is using median rates, and also averaging the cost of nursing homes throughout New York State. On Long Island, the cost of a semi-private room is right around $430/day.  That translates to $146,000 annually.  Each year.  $146,000.00.


If you find this as shocking as I do, you should contact an elder lawyer who may be able to help you protect your hard-earned assets.