Seniors tend to be particularly concerned about the likelihood that they will require nursing home
placement at some time in the future. Medical care or personal assistance provided by a caretaker
or a facility for an extended period of time is known as "long-term care." One's ability to perform
Activities of Daily Living (ADLs) is a common standard for judging whether long-term care is
required. If an individual retains the ability to perform most or all ADLs (like bathing, cooking,
walking, eating and dressing) without assistance, then long-term care probably is not required.
Care provided by family members on an informal basis and often without compensation potentially
accounts for the largest share of long-term care being provided in our country. A significant
percentage of formal long-term care arrangements offered in the home, or an institution, are paid
for through a combination of federal and state assistance programs, social and charitable
organizations, insurance and personal wealth. In addition, insurance coverage of long-term care
benefits is becoming more widely available and increasing in popularity as the cost of care rises.
There are five ways to pay for nursing home stays:
private pay, long-term care insurance, Medicare, Veteran's benefits and Medicaid. Only a small
percentage of Americans have long-term care insurance. Many individuals are medically uninsurable,
and others cannot afford the premiums for insurance. At best, Medicare pays for up to 100 days of
institutionalized care, and then only for rehabilitative stays following a qualifying
hospitalization, and only a very small percentage of nursing home residents are eligible for
Veteran's benefits. The most common alternative to private pay and long-term care insurance is
Medicaid. By carefully designing a long-term care plan, financial security may be ensured for the
spouse residing in the community, and a legacy may be preserved for children.
The rules for Medicaid eligibility are strict. The applicant must be a U.S. citizen or a resident
alien of the state in which he or she applies, and must meet state income and asset limits. In New
Hampshire, a Medicaid applicant is allowed to retain only $2,500 worth of countable assets.
Qualifying for Medicaid involves not only financial criteria but also medical eligibility
requirements. The Medicaid application itself is several pages long and the answers to each question
must be substantiated by legal or financial documentation. These supporting documents may include:
social security card, Medicare card, health insurance cards, birth certificate, marriage
certificate, life insurance policies, deeds, car registrations, household expense bills, funeral
contacts, income statements, and financial statements, all of which typically must date back one to
five years prior to the time the Medicaid application is filed.
Given the complexity of the Medicaid application and its importance to financing long-term care,
it is crucial for an applicant to receive accurate legal advice. Our professionals help guide our
clients through the Medicaid application process by informing them of all planning alternatives,
advising on all necessary steps and procedures, aiding in the compilation of the application, and
making sure that they are aware of various options that might otherwise go unrecognized.
A guardianship is a protective arrangement
established by order of the Probate Court. Guardianship is needed when an individual has lost the
mental capacity to make necessary decisions and previously failed to designate an agent under an
advance directive, or had appointed an agent but now disagrees with the individual's decisions.
There are two types of guardianship. The first is guardianship over the person, which grants and
individual - the "guardian" - authority to make personal and medical decisions for the person who
is incapacitated - the "ward." The second is guardianship over the estate, which gives the guardian
authority to make decisions concerning the ward's finances. It is possible for more than one person
to serve as an individual's guardian, and for different people to serve as guardian over the person
and guardian over the estate. Guardianship appointment requires a petition to be filed with the
Probate Court located in the county where the mentally incapacitated individual is domiciled.
Our office represents clients petitioning to obtain guardianship over an individual, as well as
individuals over whom guardianship is being sought.