Applications for Medicaid/MLTSS are still being accepted at the County Boards of Social Services

Increasing numbers of frail elderly are trying to arrange for care in their houses or apartments because admission to nursing facilities is so problematic at this time. About one third of the state’s skilled nursing facilities are considered to be incapable of appropriately isolating COVID-19 patients, and have been  barred from any new admissions. Of course, arranging for home care is increasing difficult due to a serious shortage of trained personnel who are capable and willing — understandably — to go into a home setting, due to the risk of infection. Geriatric care managers (Aging and Life Care Specialists) can be very useful in establishing a home care arrangement, even in these trying times.

The Medicaid/MLTSS program can provide home and community -based services to financially-eligible individuals who are over 65 or are disabled and who require hands-on care and supervision with 3 or more of their activities of daily living. It is necessary to contact the Office of Community Choice Options (OCCO) to order the Pre-Admission Screening (PAS). Here’s the latest list of offices and contact numbers.  MLTSS and OCCO Contact List 3.20.20

Previously, this evaluation took place at the residence of the applicant. Now it is being done by telephone. It’s very important to order the PAS because an applicant must be clinically in need of these long-term care services in order to be approved for Medicaid/MLTSS services. To do so, first the family/caregiver calls the ADRC (Aging Disability Resource Connection) in their county.  The ADRCs are sort of the portal-of-entry to gain access to many different government programs. The ADRC will complete the first telephone screening. https://www.state.nj.us/humanservices/doas/home/saaaa.html  The ADRC will then send their screening to OCCO.  The OCCO nurse will contact the family to review the initial screening and gather additional information.

 

Office of Community Choice Options:

While awaiting the PAS evaluation, it’s necessary to address the financial eligibility requirements, which are stringent and complex. Legal sandtraps are everywhere in the process. The application is then filed at the local County Board of Social Services once all of those benchmarks have been reached.

Call for advice and assistance with medicaid eligibility, applications and appeals … 732-382-6070

Health Care Proxies and Advance Directives help Doctors in critical care of patients

The New Jersey Department of Health issued a comprehensive statement concerning triage and the care of COVID-19 patients in different kinds of licensed health care facilities. This is one among many directives issued in the past six weeks. Read the directive here: FinalAllocationPolicy4.11.20v2

As the patient is being treated, many decisions need to be made along the way, often in rapid-fire fashion. The patient may not be able to communicate or make decisions. It is very important that patients or potential patients have a signed Advance Directive, or Health Care Power of Attorney (proxy) so that if the patient loses his or her capacity to make medical decisions, they have an authorized person who can communicate with the medical professionals as critical decisions need to be made. Certain treatment will be rendered automatically as a response to the patient’s emergency, but in areas where choices and decisions need to be made, it’s vital that there be a designated person. A well-written advance directive will be explicit and reasonably easy to interpret. Whenever possible, naming several back-ups to the primary Health Care Representative (decision-maker) is preferable because if the primary person cannot be reached or has become ill, having a backup to make a crucial decision is vital. If the patient is incapacitated, it would be their representative who has the discussions with the doctor or nurse pertaining to filling out the POLST formPhysician’s Orders Concerning Life Sustaining treatment — which is now a regular part of hospital practice..

We will continue to monitor developments that affect the delivery of crucial health care to our clients If you have concerns or a problem, call for a telephone consultation with one of our attorneys…. 732-382-6070

Employing Family Caregivers at this time when Home Care is More Necessary than Ever

You may wonder, “can I employ my daughter if she is living with me?” According to the National Bureau of Labor Statistics, there were over 3 million personal care aides and home health aides in the labor force in 2018, the most recent year for which data are available. In the State of New Jersey, over 41,000 people were employed in this occupation. AARP’s 2016 national survey of community caregiving found, among other things, that out of pocket costs (financial strain) on family caregivers averaged 20% of their income, with costs to care for a person over 50 or with dementia about 40% higher. The AARP 2017 survey report of family caregiving in New Jersey showed that there were over 1 million people providing some level of hands-on care to a family member. Nationwide it’s been estimated that 40 million people are engaged in family careiving.

In these difficult times as COVID-19 spreads rapidly, people are losing their jobs and in some cases, moving home with parents. The Centers for Medicare and Medicaid Services (CMS) has issued guidelines on home care, but still it is becoming difficult to set up in-home care plans due to uncertainties about exposure. If a family member is providing hands-on care, this might be a good time to look into formalizing that employment arrangement. A well-structured care plan can enable a frail or disabled person to stay at home with the assistance and support of family members.  This is the care that assists them with the Activities of Daily Living (“ADLs”)– bathing, dressing, use of the bathroom, feeding, ambulation, and transferring from bed to chair – or which provides the on-site supervision to assure safety. Home care workers are generally classified as employees by the IRS, so there will be income tax ramifications.       2020 IRS Publication 523 regarding Sale of Residence and Capital Gains TaxBut there are benefits from formal employment along with the obligations.

If a family caregiver hasn’t been in the workforce, creating a formal employment arrangement could position them for eligibility for Social Security and Medicare, State unemployment, and state temporary disability, among other things, if the employment ends Additionally, should the elder (the patient/employer) have to apply for Medicaid/MLTSS to pay for long-term care, having a formal employment arrangement could prevent certain problems that arise such as transfer penalties with family caregivers.

If Medicaid benefits will be useful and appropriate, the elder parent may want to apply for home care services through the NJ Medicaid Long Term Services and Supports program (MLTSS). Although the application process can be grueling, once approved, you can consider using the Medicaid benefits to pay your family caregiver through the Personal Care Assistant option of MLTSS.

Careful planning may also include a new power of attorney, health care power of attorney/advance directive or Last Will and Testament. There’s no time like the present to put together a new plan.

Call us to discuss family caregivers, employment contracts, estate plans and Medicaid. We have special procedures in place to conduct legal consults by phone and to help you sign your documents in a way that minimizes exposure …. 732-382-6070.

NJ Supreme Court issues Notice concerning Courts and Cases

The latest release by the NJ Supreme Court outlines the latest rules concerning trials, scheduling, closings, and so on which will affect cases, lawyers  and litigants throughout New Jersey. Cases can still be filed but numerous adjustments are being made to the deadlines and procedures. Emergencies can be addressed, and all matters are going to be handled by telephone or videoconferencing. Here is the entire Release.Supreme Court release 3-27-2020

For updated information about hearings at the Office of Administrative Law (such as appeals of Medicaid/MLTSS  denials), click HERE.  

For updated information about Medicare Hearings and Appeals, click HERE

For information about Social Security offices and hearings click HERE.

 

Stay safe, stay healthy. Call us for help with all your elder care, estate planning and special needs concerns ….. 732-382-6070

Age-Friendly Communities Conference Coming on March 11th

There’s a nationwide effort to encourage towns and cities to develop initiatives and programs that will make their communities more “age-friendly,” to encourage people to remain a part of the local community as they get on in years. Community initiatives have included outdoor upgrades such as better lighting, more benches, and better crosswalks, as well as expanded senior centers, broader library services, inter-generational local events and ventures, and expanded transportation options. The Grotta Fund for Senior Care and the Taub Foundation are co-sponsoring  the 2020 Age-Friendly Communities Conference for professionals and lay volunteers who are involved with — or want to get involved with — these efforts. The event will take place March 11th in Whippany, NJ. You can read more about it, and register, HERE.  Professional CLE credits will be available.

Click here to learn more about age-friendly initiatives. In fact, it isn’t just going on in the USA — the World health Organization has identified “age friendly” as a major important goal for communities around the world. Take a look.

Aging in place involves a partnership between people and local government, and people and their families or trusted support network. There are a variety of sources people can turn to, for help in assembling the team and making sure that structures are in place to enable them to age in place — geriatric care managers (aging & life care specialists), interior designers and contractors who can make a home more age-friendly, elder law attorneys, financial advisors, and visiting nurse services, to name just a few.

For advice about elder care and senior planning, call us at …… 732-382-6070