Walnut Creek Elder Law Blog

When choosing an assisted living facility for a loved one who suffers from dementia, certain things should be taken into account regarding the facility. More and more assisted living facilities can now accommodate residents with various levels of dementia. Some facilities have separate wings or dementia units. I have visited many assisted living facilities, and have many clients with loved ones in assisted living facilities. In addition, I have made personal observations about the quality of care for persons with dementia in these facilities.

Music: My wife’s mother, who is 89, has advanced Alzheimers disease, and has been in an assisted living facility for a number of years. Although she does not seem to recognize her children, she does respond very positively to music. When music is played for her, or if someone performs or sings for her, her face lights up. She smiles, and tries to sing. I have noticed this for many residents with dementia, when I have played jazz piano for them in various facilities. Also, on researching the subject, it seems that music is processed and understood through a different part of the brain, usually with positive results.   As a result, find out if the facility you are interested in arranges for music to be played or performed for the residents on a regular basis.

Religious Services: Another item to take into account, is whether the facility is consistent with your religious beliefs. If the resident and family are religious, it will be important for them to have the facility provide religious services for their loved one during all phases of dementia. When my father, who was Catholic, was in an assisted living facility,  I know that he cherished receiving communion every week.  

Behavior: Find out whether the facility will be able to accommodate your loved one during all stages of the disease process. Plan for the future, as the disease may progress and become worse. Ask the facility what behaviors would trigger them to say that they can no longer accommodate your loved one. Also, ask how they would handle the behavior of your loved one if he or she becomes aggressive, loud, or acts out. You will find out more if you are very specific.  

 Written Michael J. Young, lawyoung1@gmail.com, elder law attorney in Walnut Creek, CA. www.WalnutCreekElderLaw.com mike@WalnutCreekElderLaw.com. 1931 San Miguel Dr., Suite 220, Walnut Creek, CA 94596. 925-256-0298. Mr. Young, who also advises on Medi-Cal qualification, asset protection, nursing homes and the VA Aid & Attendance qualification, serves Contra Costa and Alameda Counties in CA, including the cities of Walnut Creek, Alamo, Danville, Concord, Brentwood, Pleasant Hill, Antioch, Clayton, etc.

The surviving spouse of a wartime Veteran may be eligible for the VA Aid and Attendance Pension Benefit. This benefit can help pay the costs of in home care, board and care and assisted living facilities for the surviving spouse. We must be able to show that the surviving spouse had been married to the Veteran for at least one year, or had children by the Veteran if married less than one year.

The surviving spouse is not eligible if he/she has remarried. Also, the surviving spouse must have been living with the Veteran at the time of the Veteran’s death, unless they were separated because of  medical or military reasons. The Veteran must have a discharge from the military that is other than dishonorable.  The pension rate for the surviving spouse may be as much as $1,056 per month, or $12,681 per year. 

Each VA claim is different and unique, and there are never any guarantees that any claim will be granted by the VA. When we plan for the VA Aid and Attendance Pension benefit, we also plan for Medi-Cal at the same time. Both benefits have different qualification rules, which must be coordinated.

This blog is general in nature, is for informational purposes only and is not legal advice. You should consult an elder law attorney for your particular case, and before you proceed with any planning.

Written Michael J. Young, lawyoung1@gmail.com, elder law attorney in Walnut Creek, CA. www.WalnutCreekElderLaw.com mike@WalnutCreekElderLaw.com. 1931 San Miguel Dr., Suite 220, Walnut Creek, CA 94596. 925-256-0298. Mr. Young, who also advises on Medi-Cal qualification, asset protection, nursing homes and the VA Aid & Attendance qualification, serves Contra Costa and Alameda Counties in CA, including the cities of Walnut Creek, Alamo, Danville, Concord, Brentwood, Pleasant Hill, Antioch, Clayton, etc.

In the seminars presented by Walnut Creek elder law attorney Michael J. Young, www.WalnutCreekElderLaw.com, he talks about the Veterans Affairs Aid & Attendance Improved Pension Benefit, which is paid to wartime veterans or to their surviving spouses. The program is asset and income based, as is Medi-Cal. However, the two programs have different qualification rules. The VA program is often utilized to pay for in-home care, assisted living facilities and board and care facilities. Medi-Cal is most often used to pay for skilled nursing facilities.

The VA program is “non-service connected,” which means that the disability does not necessarily result from being in the service. If you are over age 65, you are deemed to be “disabled” by the VA, and you could be eligible for the lowest amount of the benefit. If you are also housebound, you could be eligible for the next higher amount. And, if you are also in need of help with various activities of daily living, you could be eligible for the highest amount of the benefit.

 The veteran must have been discharged from the U.S. armed forces, with anything but a dishonorable discharge. Also, the veteran must have served 90 days continuously in the military, one day of which had to be during a war time. The periods of war are as follows:

•  WWI: April 6, 1917 through November 11, 1918
• WWII: December 7, 1941 through December 31, 1946
• Korean War: June 27, 1950 through January 31, 1955
• Vietnam War: August 5, 1964 through May 7, 1975
• Persian Gulf War: August 2, 1990 and continuing

The VA application, if prepared by someone other than the veteran, must be prepared “pro bono,” that is, without charge, and by someone who is accredited by the VA. An elder law attorney who is accredited by the VA is best equipped to help you with the planning and application for the VA benefit. He would also prepare an integrated long term elder care plan for you, that would take into account all of your assets, plus the VA and Medi-Cal benefits.

 Caveat: Beware of non-attorney individuals and organizations who offer to help with the VA applications. First check to see if they are accredited by the VA, which is required by federal law.  Also know that VA applications are prepared pro bono, that is, without charge. You may be advised by an organization to gift all of your assets away in a large gift, which can create immediate eligibility for the VA program, but ineligibility for Medi-Cal for a long period of time. Medi-Cal and VA have different rules. Finally, if the person or organization who wants to help with the VA application wants to sell an annuity to you as part of the process, you most certainly should get a second opinion.

This blog is for informational purposes only and is not legal advice. You should consult an elder law attorney for your particular case, and before you proceed with any planning.

Written Michael J. Young, lawyoung1@gmail.com, elder law attorney in Walnut Creek, CA. www.WalnutCreekElderLaw.com mike@WalnutCreekElderLaw.com. 1931 San Miguel Dr., Suite 220, Walnut Creek, CA 94596. 925-256-0298. Mr. Young serves Contra Costa and Alameda Counties, including the cities of Walnut Creek, Alamo, Danville, Concord, Brentwood, Pleasant Hill, Antioch, Clayton, etc.

VA BENEFITS MAY COVER THE COST OF AN ASSITED LIVING FACILITY OR IN HOME CARE

www.WalnutCreekElderLaw.com. As we discussed in previous Elder Law Today newsletters, the Veteran’s Administration provides a wonderful pension benefit for those individuals who served at least one day during a period of wartime and are now disabled due to non-service connected reasons (aging related issues,  Alzheimer’s, Parkinson’s, multiple sclerosis, and/or other physical disabilities).  This pension, referred to as “Aid and Attendance Allowance”, may pay  the long term care provided in an assisted living facility, or in-home care.  

The “Aid and Attendance” (A and A) benefit is available to a veteran who is disabled and requires the aid of another person to perform the personal functions required in everyday living.  A veteran can show they are eligible if they have a substantial need for assistance with the activities of daily living.  Such activities include bathing, dressing, meal preparation, etc.  A veteran would also qualify for this pension if they can show they need the attendance of another person in order to avoid the hazards of his or her daily environment.  The need for assistance does not have to be permanent.

 Under this program, a veteran can receive up to  $1,644.00 per month or $19,736 per year in benefits, and a widowed spouse can receive up to $1,056.00 per month of $12,681 per year in benefits.  The applicant must be “permanently and totally disabled” under the VA rules.

The vet does not need to be helpless under the rules. He only needs to show that he is in need of aid and attendance on a regular basis. Someone who is housebound or in an assisted living facility and over the age of 65 is presumed by the Veterans Administration to be in need of Aid and Attendance.

Eligibility for the program is based on the income and assets of the veteran. In determining income, deductions are allowed for unreimbursed medical expenses (UMEs). In home care workers are an allowable deduction, provided that some medical or nursing services are provided. Also, the cost of an assisted living facility, or a portion thereof, can be an allowable medical deduction against gross income. 

 In addition, a family member can provide in-home care for a veteran who is applying for aid and attendance.  In order to meet the disability criteria, the care services provided by an unlicensed relative must be prescribed by a health care professional (ex. doctor, RN, LPN or licensed physical therapist) and the professional must consult with the unlicensed relative caregiver at least once a month (in person or by telephone) to monitor the regimen.  In addition, there must be a valid care contract in place and the caregiver must be receiving no more than fair market value for services he or she is providing.

If you or someone you know is a Veteran receiving care in an assisted living facility, or at home, please encourage them to file a claim for this benefit. It would be prudent to seek the guidance of an experiended elder law attorney who is accredited by the VA.

 CAVEAT: When planning for this VA benefit, you should also plan for Medi-Cal benefits and coordinate all of this with your elder law estate plan at the same time. An elder law estate planning attorney, who is also accredited by the VA, is best equipped to help you with this planning. When seeking help for this VA benefit, always ask if the person helping you is accredited by the VA.  

 The following are some additional requirements for eligibility:

 a. Be a veteran who served at least 90 days of active duty.

b. At least one day of active duty had to be during wartime: WWII – 12/7/41 to 7/25/47 – Korea – 6/27/50 to 12/31/55 – Vietnam – 8/5/64 to 5/7/75;

c. Does not need to have been in combat;

d. Discharged other than dishonorably;

e. Income less than $1,644 per month, once out-of-pocket medical expenses are considered.

f. Net worth less than approximately $50,000 for singles or $80,000 for couples.

g. Gifting of assets is allowed with no look-back period, but must be coordinated with Medi-Cal planning and gifting, which does have a look-back period.

 If you or someone you know is a Veteran receiving care in an assisted living facility, or at home, please encourage them to file a claim for this benefit. It would be prudent to seek the guidance of an experiended elder law attorney who is accredited by the VA.

Elder Law Today is written by Michael J. Young, Attorney at Law, 1931 San Miguel Dr., Ste. 220,  Walnut Creek, CA 94596. This information is for general informational purposes only, and does not constitute legal advice. For specific questions, you should consult a qualified attorney. MIKE@WALNUTCREEKELDERLAW.COM

For additional information, such as upcoming seminars, past newsletters, and to listen to an interview with attorney Michael J. Young, visit  www.WalnutCreekElderLaw.com.

Office: (925)-256-0298

UPCOMING SEMINARS BY ELDER LAW ATTORNEY MICHAEL J. YOUNG:

Dates: Fridays, January 8 and 22, from 2:00 to 3:30 p.m. at the Law Offices of Michael J. Young, in the Channell Room. For reservations call 925-256-0298.

             For Medi-Cal eligibility, the single applicant must have no more than $2,000 in non-exempt assets in her name. If you just give away your assets, without proper planning, and you want to enter a nursing home, you may create a period of ineligibility for Med-Cal. The ineligibility period begins at the date of the transfer.

             Medi-Cal presently has a 30 month look back period, and they use a divisor of $5,698, which is known as the average private pay rate (APPR). This figure is used to determine the period of ineligibility. So for example, if you transfer $20,000 to a family member, and divide that figure by $5,698 you will have 3.5 months of ineligibility. This is rounded down to three months of ineligibility from the date of the gift. If this gift is made in November, 2009, the applicant would be ineligible for November and December of 2009, and ineligible for January, 2010. She would be eligible in February, 2010.

            If $200,000 is transferred to another individual, (divided by $5,698), 35 months of ineligibility is created. However, Medi-Cal presently has a 30 month look back period. So, after 30 months have passed from the date of this transfer, the applicant would be eligible for Medi-Cal.

             There are also acceptable and legal methods for transferring assets, among family members for instance, which create fewer months of ineligibility. An elder law attorney familiar with nursing home and Medi-Cal eligibility can advise you on these matters.

            By, Michael J. Young elder law attorney in Walnut Creek, CA.

            Mr. Young is an elder law attorney who practices in the east bay. His office is in Contra Costa County, located at 1931 San Miguel Dr., Ste. 220, Walnut Creek, CA. Mr. Young has East Bay elder law clients who live in such towns as Brentwood, Antioch, Concord, Alamo, Walnut Creek, etc.  Many of his clients are concerned about how they will pay for their nursing home costs. Mr. Young prepares long term care plans for his clients, which may include utilizing Medi-Cal and the Veterans Administration Aid and Attendance Benefit for wartime veterans. www.WalnutCreekElderLaw.com  Lawyoung1@Gmail.com 925-256-0298

Parkinson’s disease is a brain disorder, wherein certain nerve cells in the brain become impaired or die. These nerve cells, called “neurons” normally produce a chemical known as dopamine. This chemical allows for smooth, coordinated functions of the body’s muscles and movements.

When a high percentage of the brain cells which produce dopamine are impaired, symptoms of Parkinson’s disease may appear. Symptoms may include tremors, changes in facial expression, imbalance, small handwriting and slowness of movement. In time, the symptoms may become worse. Mild tremors can become more severe. Body movements may also become slower, and mobility problems may become worse. The use of eating utensils, dressing, and performing various activities of daily living may become more difficult.

Parkinson’s disease, which is difficult to diagnose officially, affects both sexes in equal numbers, and does not discriminate on the basis of ethnicity, social status or where you live. There are different rates of progression for the disease. We encourage our clients who have Parkinson’s disease and their familiy members to seek the help of support groups, to pursue ongoing medical care, and to learn adaptive techniques from medical professionals.

 Parkinson’s disease is the most common brain disorder, after Alzheimer’s disease, that we see with our clients. When symptoms of Parkinson’s disease appear, as with symptoms of Alzheimer’s disease, we receive inquiries from individuals who may have the disease, or from their loved ones. They want know what should be done now regarding the establishment of a long term care plan for the person with the disease.

We help clients review and update their existing estate planning documents, to be sure the documents contain the requisite asset protection language. We then help the family plan for long term in-home care, which is the preference of most of our clients. We help the family plan for the VA Aid and Attendance benefit, which can help pay for in home care, for veterans. We also help with planning for Medi-Cal benefits, which can pay for nursing home care.   

 If you or a loved one has symptoms of Parkinson’s disease, please feel free to call elder law attorney Michael J. Young, with offices in Walnut Creek, CA, at 925-256-0298. Mr. Young serves clients principally in Contra Costa and Alameda Counties. You can visit our web site at www.WalnutCreekElderLaw.com