Beauty and pleasure of growing old with a positive attitude

New York Times writer John Leland wrote a marvellous, lengthy article that was published by the Times on December 31st. Three years ago, he began following the life activity of six New Yorkers who are in their 90’s. I just loved the article and wanted to give it a “shout-out” here. Click HERE for link to read the piece for yourself. One woman told him, “What keeps me going is when you’re lively. You’ve got to be lively.You can’t be an old beckyhead.” I’m not sure what that word means, but she found a new romance at the nursing home where she must live — another resident who is also in his 90’s.

I wrote this song in honor of people like these. I call it “Two O’Clock.”

“This nursing home’s a lovely place, I walk the halls with style and grace. My sweaters match my pants and scarf. A nice red bracelet tops it off.

“They help me dress, they help me groom. I lose my way, can’t find my room. At dinnertime, they come for me. They bring me cookies with my tea.

“You think I’m just like her, or her. Aged body, mind a blur. But I’m still here, please don’t forget: I was a dancer. I’m not gone yet.

I once was up there on the stage, my name in lights on Style page. I leapt, I whirled, was caught mid-air, a bird in flight, such brilliant flair! And I performed in many halls, adored the thrill of curtain calls. I had such fans, they followed me, from town to town and big cities.

“Now every day is just the same. I can’t remember my last name. And sometimes when they look at me, I wonder what it is they see, BUT!! Two o’clock is time to dance! I’m in the limelight, it’s my chance,  to whirl, to reach, to take a bow, I was a dancer, I’m still here now. Yes two o’clock it’s time to dance, and I’m still here, it’s still my chance…  to whirl, to reach to take a bow, I AM a dancer, I’m still here now.”

 

Call for elder care planning for a good old age … 732-382-6070

 

 

NJ Medicaid raises spousal maintenance allowance; options still exist to increase the share of resources

Effective July 1, the State of New Jersey Division of Medical Assistance and health Services (DMAHS) has raised the Minimum Monthly Maintenance Allowance (MMMNA) for the spouse of a person who is on Medicaid. For residents of nursing homes, the general rule is that all of the resident’s income must be turned over to the facility as a cost-share, except for authorized deductions which include support of a spouse if the spouse’s own income is less than the Maintenance Allowance. The NJ MMMNA is now $1,991.25. The relevant regulation is N.J.A.C. 10:71-5.7, and here is the new MedCom No. 15-09, dated July 1m 2015.

15-09_2015_Community_Spousal_Maintenance_Allowance

In calculating the amount of this spousal support deduction, an excess shelter allowance is provided if shelter costs are in excess of $597.38. Also, if the spouse pays for utilities, a utility allowance of $491.00 per month is added to the base MMMNA.

Typically, these calculations are not done until after the applicant has been found to be resource-eligible (“after the spend-down”). This does not mean that all the excess assets have to be spent on the nursing home, and there are techniques available which we use regularly, that preserve substantial assets for support of the spouse.

Also, in some cases, the combined income of the spouses will not be enough to provide the spousal support amount. There is a special regulation for those cases, in which the community spouse can keep more assets than usual because the income is too low. N.J.A.C. 10:71-5.7(d) and N.J.A.C. 10:71-8.4. This is based on the federal statute at  42 USC 1396r-5(e)(2)(C). These issues have to be addressed at the earliest possible time,  before the couple embarks on a spend-down. This protection of extra assets can only be obtained by going through a hearing process at the NJ Office of Administrative Law. New Jersey is an “income-first” state, which means that before the extra resources can be set aside for or transferred to the community spouse, all income must be made available. The U.S. Supreme Court dealt with this issue in  Wisconsin Dep’t. of Health v. Blumer, 534 U.S. 473 at 484, 151 L. Ed.2d 935 at 946, 122 S. Ct. 962 at 969, 151 L. Ed.2d 935 (2002).

First, the income of the community spouse is applied toward their maintenance amount. Then, the income that the institutionalized spouse is earning or receiving (such as pension or Social Security retirement) at the time of the fair hearing is considered. If there is a pending receipt of income based on a prior award notice, that income would also be taken into account (such as where they had received notice that they would be receiving Social Security Disability income as of a certain date). If there is still a “gap,” there is a basis to ask for an increase in the community spouse resource allowance or CSRA to set aside additional resources for the community spouse.

Call us for legal advice on Medicaid eligibility and asset protection, and to prepare your medicaid applications and appeals … 732-382-6070

Monitor the social/emotional care plan for your loved one in a nursing home

If you are the advocate for someone in a nursing home — your spouse, parent, friend, relative — you may sometimes notice unusual behavior which is different from what you are accustomed to seeing with your loved one. Speak up. Ask the social worker what has changed. Is there a new roommate? A different aide waking the resident up in the morning? Is there another resident who is bothering your family member? Is there a new low grade medical condition such as a urinary tract infection, dental problem or pain? Why is the resident more fidgety, anxious, or quiet? What is causing these “Mental and Psychosocial Adjustment Difficulties?” This issue pertains to the resident’s difficulty in adapting to change in routine or to  stressors  they cannot understand.

Federal nursing home law, 42 CFR secn. 425,  requires that  ” Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care.”  On the subject at hand, section (f) says:” Mental and Psychosocial functioning. Based on the comprehensive assessment of a resident, the facility must ensure that—

(1) A resident who displays mental or psychosocial adjustment difficulty, receives appropriate treatment and services to correct the assessed problem, and
(2) A resident whose assessment did not reveal a mental or psychosocial adjustment difficulty does not display a pattern of decreased social interaction and/or increased withdrawn, angry, or depressive behaviors, unless the resident’s clinical condition demonstrates that such a pattern was unavoidable.”
The mental and psychosocial needs of each resident must be continually addressed on an individual basis to take into account the ability of the individual resident and changes in behavior or mood that become apparent from time to time. Detailed guidelines called SOMS have been issued by the federal government to further explain the duties created by the regulations:  som107ap_pp_guidelines_ltcf

I came across a book that was written for nursing home administrators but could be a useful guide to the lay advocate who is watching out for a loved one in a nursing home. http://ltcsbooks.com/books/social-service-care-plans The book is Psychosocial Care Plans: Social Services Care Plans for Long Term Care,  By Debra Collins, RN, RAC-CT.

Remember – the squeaky wheel gets the oil, and nursing homes have a duty to provide a plan which addresses your loved one’s problems.

For legal representation and advice on nursing home admission and care plans, contact us at 732-382-6070.