10 considerations when your spouse needs nursing home care
1. Try to have your spouse stay in the hospital as an inpatient for a minimum of 3 nights before going to the nursing home. Medicare and/or private insurance will pay for a short term rehabilitation, up to 100 days, if you spend 3 nights in the hospital as an inpatient. This does not apply to a patient in the hospital under observation status. You should ask whether your spouse was admitted as an in patient.
2. When your spouse is discharged from the hospital for rehabilitaion, you should try to get into the best nursing home possible. Ideally, you should find a nursing home close to your home, that provides quality care and accepts MassHealth benefits. Be sure to find the best place possible, in case your spouse needs to stay for long term care in the nursing home. It is often difficult to move your spouse to a nursing home later, especially if they will be applying for MassHealth.
3. Most nursing homes accept MassHealth (also known as Medicaid). You will not be in a lower quality nursing home or receive a lower standard of care because you are a MassHealth recipient.
4. Do not expect to receive Medicare and/ or private insurance coverage for rehabilitation for the full 100 days. In order to receive coverage for this time period, your spouse must continue to make progress toward his/her rehabilitation. Those diagnosed with dementia, or Alzheimer's disease are usually considered to need "custodial" care and rarely receive coverage for the full 100 days. Medicare imposes a co-pay after the first 20 days. If you have private insurance it may cover this co-pay.
5. Seek advice from an elder law attorney as soon as possible to help protect your assets. Every day you wait could cost you $300 - $400, or more. You may think that you have too much money to qualify for Masshealth. However, in most cases, we can protect the assets for the spouse remaining at home. You should make a list of your assets and how they are held (i.e.: Jointly, individually, in trust, etc.). Youshould also locate any existing estate planning documents. Don't worry if you don't have any estate planning documents. Time is of the essence and you should seek help immediately.
6. Do not let the nursing home prepare the MassHealth application for you, even if it is free. In most cases, the nursing home has conflicting interests. They are not concerned about protecting assets for the spouse at home. You risk losing a chance to protect your assets, if you let the nursing home provide you with guidance.
7. If you have a trust, it does NOT mean that your assets are protected. There are many types of trusts. Revocable trusts will always be considered an asset available to pay for nursing home care. Irrevocable trusts may or may not be considered as an available asset. Be sure to have an elder law attorney review any trusts that you may have. In some cases, you may need to re-title your assets to protect the assets for the spouse at home.
8. If you have given away any money within the past 5 years it will result in a "penalty period". If you have given away money (more than $500) to someone other than your spouse within the past five years , there will be a penalty period. This means that there will be some period of time where MassHealth will not pay for coverage. In some cases, this can be "cured" by giving back the money. Any transfers of assets within five years of applying for MassHealth will be scrutinized. You should consult with an elder law attorney.
9. You may need to change your estate planning documents and or beneficiary designations. Most married couples plan to leave everything to each other at the end of life. However, if your spouse is in a nursing home, this may be a bad idea. An elder law attorney can discuss estate planning options for you.
10. Do not panic. In most cases your assets can be protected and your spouse can receive the care that they need. It is important that you receive the right advice as soon as possible. We can provide you with a plan and help you one step at a time in making sure your spouse gets the care that he/she needs and that you are protected.
Senior Solutions Attorneys at Law, 30 Church Street, Suite 210, Belmont, MA 02478
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