Elder Lawyer in Ft. Washington PA, Pennsylvania, PA, PA Elder Law, Living Wills, Powers of Attorney, Medicaid, Estate Planning

Practice Areas

Long Term Care Planning and Placement

On July 21, 2008, the National Association of Area Agencies on Aging (n4a) introduced a new "online navigational tool to help older adults search for senior housing, no matter where they live." The resource was described in n4a's Press Release, entitled "National Association of Area Agencies on Aging rolls out nationwide senior housing resource during annual meeting in Nashville."
Powered by SNAPforSeniors®, the Senior Housing Locator makes objective, nationwide information available 24-hours a day, seven days a week through the convenience of the Internet.

Consumers and professionals alike will now have access to the n4a Senior Housing Locator through a link on n4a.org.

The tool allows users to search a database of more than 60,000 senior housing listings, including all licensed senior housing in the nation.
 
 
 
Nursing Homes

A nursing home is a facility where residents receive round-the-clock nursing care designed to help an individual with the activities and needs of daily living and health care. These residents do not need the kind of acute health care provided in a hospital. A person usually enters a nursing home after all other long term care options, such as an assisted living facility or living at home with supportive services, are found to be inadequate.
Medicare does not provide substantial coverage for long term nursing home care. Medicare may pay for a portion of the cost for the first 100 days of a nursing home stay, under very limited circumstances. 

Those circumstances are:
  • Skilled nursing or rehabilitation services are provided within 30 days of a Medicare covered hospital stay of more than 3 days;
  • A doctor certifies the resident’s need for skilled care on a daily basis;
  • Skilled care is actually received on a daily basis;
  • The facility is Medicare-approved.
  • If these requirements are met, Medicare will fully cover the first 20 days of skilled care and a portion of the cost for the next 80 days of skilled care. Note that Medicare does not cover custodial care.
Assisted Living Facilities

Assisted living is housing for older individuals who need some assistance with the activities and needs of daily living and perhaps some medical help, but who do not need the degree of care provided in a nursing home. The goal of an assisted living facility is to help people live as independently as possible.
An important benefit of residency in an assisted living facility is help with medication. 

A resident can be reminded when to take medication and a nurse can assist the resident in taking medications.
 
Payment for residency in an assisted living facility is almost exclusively through private arrangements with the resident. Neither Medicare nor Medicaid covers residency in an assisted living facility. If a resident needs some sort of skilled medical or nursing care, Medicare may cover such care under the same rules that would apply to home health care in general. Long term care insurance will pay benefits for residency in an assisted living facility if the policy’s “benefit triggers” requirements are met by a resident’s need for assistance with activities of daily living or by a resident’s cognitive impairment. Most long term care insurance policies define “activities of daily living” as including dressing, eating, bathing, toileting and transferring from a bed to a chair, and usually require that an individual needs assistance with a certain number of these activities of daily living.

 
Questions

Upon entrance to an assisted living facility, a prospective resident should carefully review the admission contract. Significant issues to consider in evaluating an admission contract include:
 
  1. What personal care services are to be provided? Who delivers these services?   Is the service provider licensed or certified?
  2. What are the monthly or other charges for such services? Are housekeeping services included? How can fees be increased and what happens if fees are increased and a resident cannot afford the higher fee?
  3. In the case of a married couple, what happens upon the death of a spouse? 
  4. Is a change of living unit required? How would fees be affected? 
  5. What recreation or cultural activities are available and are they included with the monthly fee?
  6. Is transportation provided to such things as doctor appointments, shopping and community activities? Is a separate fee charged?
  7. Are nursing services available at the site? What happens if a resident’s health declines? Is the facility responsible for coordinating medical care?
  8. How does the facility determine the point at which a resident cannot be served by the facility? What recourse does a resident have to challenge the facility’s decision? Is there a grievance process?
     
Continuing Care Retirement Communities (CCRC)

Continuing care retirement communities provide different levels of care based on the particular needs of the individual resident. New residents usually move into independent living units. As they age and become physically disabled and need assistance with the activities and needs of daily living, residents move to an assisted living facility located on the grounds of the continuing care retirement community. Some continuing care retirement communities provide assisted living services in the independent living units so that a resident does not have to move.  If physical decline continues and more intensive care is needed, nursing home care is also available within the confines of the continuing care retirement community.
 
Upon entrance into a continuing care retirement community, a resident enters into a contract whereby the continuing care retirement community agrees to provide housing, certain levels of activities and health care support as needed in return for the resident’s payment of an entrance fee and monthly occupancy fees. In most cases, residents do not own their living unit. The services offered can vary; most provide house-cleaning, laundry facilities and at least some meals. The monthly fee for residents who move into the assisted living or nursing home facilities may be higher than if they had remained in an independent living unit.
 
A careful review of the contract, preferably by an elder law attorney, is advised to make sure the resident understands the terms. Some continuing care retirement communities offer unlimited health services in exchange for the entrance fee, while others require that residents pay additional fees for health care services as they are needed. Still others offer a combination of the two. The fee-for-services arrangement is becoming increasingly more common. Other important issues to be reviewed in a continuing care retirement community contract are:
 
  1. Who determines when a resident must change living arrangements due to a decline in health?
  2. What are a resident’s rights and responsibilities with regard to furnishing and altering their living unit?
  3. Under what circumstances would the entrance fee be refundable?
  4. Under what circumstances can the monthly service fee be increased?
  5. What services are not covered by the monthly service fee?

Pennsylvania law mandates that all continuing care retirement community contracts:
  • provide for continuing care;
  • specify all services to be provided and provide that a resident cannot be liable to a health care provider for services that the continuing care retirement community promises to furnish;
  • describe any exclusions or limitations on coverage for pre-existing conditions;
  • provide for termination by either party upon 30 days written notice and the terms for refund upon termination;  
  • contain notice of rescission rights before moving in.

The advantages of living in a continuing care retirement community are:
  1. An individual whose health declines can move into an assisted living unit or, if necessary, to a nursing home within the same residential community.
  2. Payment of the entrance fee locks in a fixed price for continuing care at an amount that is usually less than the market rate for nursing home care. For this reason, some people consider a continuing care retirement community as a form of long term care insurance. However, if there will be a substantial increase in the monthly service fee upon moving into the assisted living or the nursing home portion of the continuing care retirement community, there could still be a need for long term care insurance.
     
  3. A couple that moves into a continuing care retirement community ensures that, if one spouse must enter the nursing home, the other spouse will be living on-site and can easily visit.
     
  4. Because a continuing care retirement community comprises both assisted living and nursing home care, different activities within the continuing care retirement community can be governed by different laws and regulations. Residents would be protected by the laws that apply to assisted living facilities while they are receiving assisted living services and they would be protected by the laws that apply to nursing homes when residing in the nursing home component of the continuing care retirement community. 

Personal Care Homes

Personal Care Homes, sometimes erroneously called “assisted living facilities,” offer room and board and assistance with the activities of daily living (such as bathing, grooming and meal preparation, taking prescription medication) but do not offer the level of care required to be offered by a hospital or nursing home or an assisted living facility, which must adhere to specific regulations for the health and safety of their residents.