The Continuum of Care

Hook Law News | Aug 14, 2020 | Emily A. Martin

As people age, there are several types of care that they may need in order to allow them to maintain the highest quality of life possible. Depending on which type of care you or a loved one may need, there are a variety of legal issues and estate planning techniques that can be implemented. These strategies can allow you to preserve your assets while aging with dignity.

In-home care

The first step that many people take when they become unable to care for themselves is hiring an in-home caregiver. This is someone who comes into the home and helps seniors with tasks around the home like cooking, cleaning and household chores as well as assistance with bathing, toileting, and other activities of daily living. In-home caregivers can be individually employed or can work for an agency. If you hire an in-home caregiver, their compensation can be counted toward your monthly medical expenses for the purposes of qualifying for VA Aid & Attendance benefits. If you are receiving these benefits or working to be eligible for them, it is important that you meet with an experienced elder law attorney in order to make sure your caregiver expenses are properly documented for these purposes. Additionally, Medicaid covers the cost of in-home care for some individuals, but those caregivers have to be authorized by Medicaid, and Medicaid does not cover round-the-clock care.

Rehabilitation facilities

If you or a loved one has surgery or suffers a fall or other medical event, you may spend some time in a rehabilitation facility before you are able to move back into your home. During a stay in this type of facility, you will recover from the medical event that led to your stay as well as undergo physical, occupational, and/or speech therapy sessions. Without a proper plan in place, your assets could be significantly depleted by a stay in a rehabilitation facility, especially if that stay has to be extended due to a slow recovery time. An elder law attorney can also advise you as to what benefits you might be able to receive to help cover the cost of rehabilitation.

Independent living communities

Many people who reach retirement age find that it is no longer easy to do everything that is required to maintain a home, and therefore they downsize by moving into an independent living senior community. These communities are often limited to people over a certain age, such as 55. Independent living communities do not provide assistance with activities of daily living. If you require additional care, many communities allow you to hire caregivers to come into the community to assist you with daily tasks. People who choose to live in independent living are often completely able to take care of themselves, but they may wish to live close to people who are close in age and share similar interests with them. This can be a great option for people who have reached retirement age but suffer from very few health problems. If you are thinking about moving into an independent living community, it is important to meet with an elder law attorney beforehand to discuss ways to position your assets in the best way possible for this type of care. Although it is not as expensive as assisted living or nursing home care, the costs can begin to add up.

Assisted living communities

Many seniors make the decision to enter an assisted living community when a medical or memory issue makes it impossible for them to live independently. Assisted living residents may need help with some aspects of daily living; however, they do not need 24/7 nursing care. In an assisted living community, residents will get help with housekeeping, laundry, transportation, and dining. Additionally, nurses and other medical aides are on staff 24/7 in case you suffer a medical emergency requiring immediate attention. Although Medicaid does not cover assisted living care, it is important that you visit an elder law attorney before entering into an assisted living facility. Accessing Veteran’s Benefits and other planning techniques can allow you to preserve your assets from the high cost of assisted living expenses.

Nursing homes

When you require round-the-clock care, you may choose to move into a nursing home. Nursing home residents have health needs that require constant care from a highly skilled professional, such as a nurse or doctor. These facilities provide all of the services that assisted living facilities provide on top of the highly skilled medical care. Because nursing home care in Virginia costs an average of over $8,000 per month for a private room, it is vital to meet with an elder law attorney so that your assets can be shielded from the devastating costs of this type of care. At this time, there is a five-year lookback period for Medicaid eligibility. This means that, once you create an irrevocable trust to preserve your assets from being spent down for Medicaid, you must wait five years before you can immediately qualify for Medicaid. If there is any possibility that your health may decline to the point of needing nursing home care within the foreseeable future, it is crucial to meet with an experienced elder law attorney as soon as possible. While there are crisis planning techniques that can be used to shield assets once you are already in a nursing home, it is always best to plan ahead as much as possible.

Hospice care

Hospice care is typically the last step in the continuum of care. Typically, a person goes into hospice care when a doctor diagnoses them with a medical issue that means they have six months or less to live. At this point, care is often focused on palliative measures to keep the patient as comfortable as possible before they pass away. If a loved one is in hospice or may be close to needing hospice care, it is important to consult an elder law attorney about any end-of-life issues that may come up in the event of the death of your loved one. This can include probate and estate administration issues as well as funeral planning.

As illustrated by these various levels of care available to seniors, each stage in a senior’s life requires different planning techniques and raises a variety of concerns. Because each person’s health, family, and financial situations are different, it is always a good idea to meet with an experienced elder law attorney who can help you position your assets and record your wishes to create a specialized plan that will work for you and your family.

Ask Kit Kat: Survival vs. Personality

Hook Law Center: Kit Kat, what can you tell us about how personality affects survival of a species vs. the species’ physical strength?

Kit Kat: Well, this is very interesting! One might think that strength or brawn might outweigh a friendly personality, but scientists have some interesting information on this topic. Take for instance dogs. Dogs evolved from wolves, and they have been quite successful! According to scientists Brian Hare and Vanessa Woods of Duke University, “They (dogs) were attracted to humans and became friendly to humans, and changed their behavior, appearance, and developmental makeup. Sadly, their close relative, the wolf, is threatened and endangered in the few places where they live, whereas there are hundreds of millions of dogs.”

Other examples include how plants and animals work together to pollinate plants. Unwittingly, the two work together in harmony. According to Hare, “The plants provide food and energy, while the animals provide transportation for the pollen.” Also, we can look at bonobos as compared to chimpanzees. Bonobos are natural sharers, and they work together collectively to gather food. Bonobos also are less violent. Male chimpanzees become more selfish as they age, and often fight with other male chimpanzees, sometimes resulting in death. A benefit of this cooperative form of living is that, “The friendliest male bonobo is more successful than the unfriendliest chimpanzee. The most successful bonobo males have more offspring than the most successful alpha male chimpanzees,” according to Hare.

So, in taking the long view of evolution, it appears that nature points the way—being cooperative and friendly wins the day. To apply this to humans, aren’t the nations and civilizations which had long periods of peace, the ones which have created lasting monuments and institutions? It’s a lesson which should be applied more often today, especially in the area of politics. We end the discussion here, but it is definitely something to consider. (Marlene Cimons, “ “Friendliest, not fittest, is key to evolutionary survival, scientists argue in book,” The Washington Post, July 20, 2020)

Emily A. Martin

Attorney, Shareholder
757-399-7506 | 252-722-2890
[email protected]

Emily A. Martin is a Shareholder of Hook Law practicing in the areas of elder law, estate and trust administration, estate planning, asset protection planning, litigation and dispute resolution, guardianship and conservatorship, long-term care planning, special needs planning and financial planning. To date, Ms. Martin has overseen over 100 guardianship and conservatorship matters. In addition to being admitted to the Virginia State Bar and North Carolina State Bar, she is licensed to practice before the Department of Veterans Affairs. Ms. Martin is a member of the National Academy of Elder Law Attorneys and Virginia Academy of Elder Law Attorneys. She is a graduate of the University of Mary Washington and Regent University School of Law. Prior to joining the firm in 2018, Emily worked as an estate planning and elder law attorney in Virginia Beach for several years.

Practice Areas

  • Elder Law
  • Estate & Trust Administration
  • Estate Planning
  • Asset Protection Planning
  • Guardianship & Conservatorship
  • Long-Term Care Planning
  • Special Needs Planning
  • Financial Planning
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