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Raising the minimum wage by as little as 10 percent would significantly improve the safety and health of nursing home residents, according to new research.

Most direct care in nursing homes is provided by nursing assistants, who make up about 40 percent of the nursing home workforce and are among the lowest-paid workers in the U.S. economy. Nursing assistants help residents with activities of daily living like eating, bathing and dressing, and and work with certified nurses and elder care teams to monitor patients’ conditions.

Due in part of their low wages, nursing assistants frequently change jobs for better pay or working conditions.  “Between 60 percent and 85 percent of nursing assistants leave their employers each year, most often to go work in other nursing homes,” writes Krista Ruffini, a visiting scholar at the Minneapolis Federal Reserve. Nursing homes frequently report difficulty in recruiting and retaining staff, she says.

Ruffini recently looked at the impact increasing the minimum wage has on nursing home staff turnover and quality.  She compared facilities in hundreds of U.S. counties that had increased their minimum wage with those that hadn’t between 1990 to 2017.

In findings based on her preliminary data published in a working paper, Ruffini found that “increasing the minimum wage by 10 percent would reduce the number of health inspection violations by 1 percent to 2 percent, the number of residents with moderate to severe pressure ulcers [bed sores] by about 1.7 percent, and the number of deaths by 3 percent.”  The 3 percent reduction in deaths, she notes, translates to 15,000 fewer deaths in nursing homes each year.

Ruffini found that raising the minimum wage reduced turnover and increased tenure among nursing assistants.  This greater continuity of care, she says, translated into improved health and safety conditions for the patients.  At the same time, nursing home profits held steady because the extra costs were passed on in the form of higher fees.

Ruffini notes that her findings have particular relevance in a time when the coronavirus pandemic is overwhelming nursing homes.  Comparing a facility’s number of COVID-19 deaths with its quality-of-care performance, she concluded: “The data provide some suggestive evidence that higher service quality is associated with fewer deaths from COVID-19 in nursing homes.”

For Ruffini’s paper, click here.  For an article she wrote about her findings, click here.

For a New York Times article on Ruffini’s research and another minimum wage study, click here.

 

Medigap policies that supplement Medicare’s basic coverage can cost vastly different amounts, depending on the company selling the policy, according to a new study. The findings highlight the importance of shopping around before purchasing a policy. 

When you first become eligible for Medicare, you may purchase a Medigap policy from a private insurer to supplement Medicare's coverage and plug some or virtually all of Medicare’s coverage gaps. You can currently choose one of eight Medigap plans that are identified by letters A, B, D, G, K, L, M, and N (If you were eligible for Medicare before January 1, 2020, but not enrolled, you may also be able to purchase Plans C and F, but those plans  are no longer available to people who are newly eligible for Medicare). Each plan package offers a different menu of benefits, allowing purchasers to choose the combination that is right for them. 

While federal law requires that insurers must offer the same benefits for each lettered plan–each plan G offered by one insurer must cover the same benefits as plan G offered by another insurer–insurers set their own prices for each plan. This means that the price of each plan varies considerably depending on the insurance company. 

The American Association for Medicare Supplement Insurance compared costs of plans in the top 10 metro areas and found huge cost differences. Using the most popular plan–Plan G–for comparison, the association found that in Dallas the lowest price for a 65-year-old woman to purchase a plan was $99 a month while the highest price was $381 a month. This is a yearly difference of more than $3,000 for the exact same plan. 

The association also found that no one company consistently offered the lowest or highest price. In their study, investigators discovered that 13 different companies had either the lowest or highest price. This means you can’t rely on just one company to always have the better price. 

When looking for a Medigap policy, make sure to get quotes from several insurance companies. In addition, if you are going through a broker, check with two or more brokers because one broker might not represent every insurer. It can be hard work to shop around, but the price savings can be worth it.

 

Stay-at-Home Orders and fear of infection from COVID-19 have left many families struggling to manage the care needs of their aging loved ones.  Taking care of a parent can be a full-time job, often resulting in the child’s own employment being sacrificed along with their own financial security, family time, and freedom. Some families have been able to “make do” over the past 3 months by being able to work from home and care for their loved one simultaneously.  However, as we begin to re-enter traditional work environments, or plan for a return in the fall, many of us have not yet contemplated how we will arrange for the care of our elderly loved ones. While some may be considering in-home care, they may also be finding that full-time in-home care is just as expensive, or even more expensive than 24-hour a day facility care. During this uncertain time, what real solutions exist?

Medicaid, or Medical Assistance as it’s referred to in Pennsylvania, provides in home care through two different programs, the Community Health Choices Waiver Program, and the LIFE (Living Independently For Elders) Program. Although this is not 24-hour care, these programs do provide a nursing home alternative for those who may have family support or resources. And before you assume that there is no way you can be eligible for a Medicaid Program, you should understand that YOU may be exactly the person to whom we are speaking, and if so, then we can get you eligible.  Medicaid, as with any government program, has rules to follow for eligibility and this is where our experienced Elder Law Attorneys at Zacharia Brown can advise you and develop a plan for eligibility and the protection of assets.

  • The Waiver Program is a Home and Community Based Waiver Services program for individuals age 60 and older. The purpose of this program is to provide support and services to individuals living in their homes and communities.  Some examples of what the Waiver Program may provide are: in-home care for assistance with activities of daily living, meal preparation, housekeeping, transportation services, respite, service coordination, home delivered meals, telecare, accessibility adaptions, equipment, technology and medical supplies, among a whole host of other supplies and services. These services can be provided by an agency (many of the agencies you see out in the community participate in the waiver program), a private credentialed provider, or even a family member who will be able to receive the waiver funds for the care that they are providing. This program requires the submission and approval of a Medicaid Application. If you are a married couple or an individual and have assets and income that are in excess of the immediate Medicaid eligibility criteria, Zacharia Brown will represent you in devising a Medicaid Application Plan for the protection and planning of your assets and income to attain eligibility.
  • The LIFE Program is a care program that provides a comprehensive, all-inclusive package of medical and supportive services. The program partners with caregivers to provide quality care for their loved ones and provide help, support, and peace of mind. The program also provides transportation, coordination of Medicare and Medicaid Services, and prescription medication at no additional cost to the participant.  The ultimate goal of the program is to help members live independently in the community for as long as possible with a focus on preventive care. This program can be paid for privately, however to receive the services at no cost, it requires the submission and approval of a Medicaid Application. If you have assets and income that are in excess of the immediate Medicaid eligibility criteria, Zacharia Brown will represent you in devising a Medicaid Application Plan for the protection and planning of your assets and income to attain eligibility.

The Veterans Administration also provides financial support to wartime veterans or their surviving spouses who are incurring care expenses.

  • Veterans Benefits Planning is an often overlooked and misunderstood program because of the uncertainty as to one’s eligibility and because of what is perceived to be a rigorous process to attain eligibility. The VA Pension benefit provides a monthly payment for qualified Veterans and survivors that need assistance with activities of daily living, if they’re housebound, or Veterans that have qualifying medical expenses of a spouse. This is an often utilized benefit for those wishing to receive care in the home by a home healthcare agency, a child or other family member, or by residing in an assisted living or personal care home.  Planning and understanding the rules for eligibility are critical in making sure that your application doesn’t get caught up in red tape and take years to ultimately receive a denial rather than being approved.

Zacharia Brown often utilizes Caregiver Agreements in working toward attaining financial eligibility for Veterans.

  • Caregiver Agreements. Caregiving is usually unpaid work, however, parents who wish to compensate a child who takes on the role of caregiver may do so through the use of a Caregiver Agreement. Caregiver agreements are an increasingly popular way to ensure that a child is compensated for their caregiving assistance. A caregiver agreement (or personal care contract) is a contract between a parent and a child (or other family member) in which the parent agrees to reimburse the child/family member for caring for the parent. These agreements have many benefits. First, they provide a way to thank a family member who is caring for an ailing parent. Second, they can help to alleviate tension between family members by making sure that a caregiver is fairly compensated. Most importantly, these agreements can also be a key component of Medicaid and VA planning when used properly. One downside to caregiver agreements is that the income is taxable to the caregiver, and aside from taxation, can cause reductions in a child’s social security retirement or unemployment compensation benefits. Therefore, it is essential that these agreements be drafted by an experienced elder law attorney.

The most important thing to know is that THESE RESOURCES DO EXIST, but they take time to get in place.  If you are planning to return to work in the fall, the time to act is NOW! We can help you protect your life savings and guide you through the process of eligibility for these in-home programs.

For help with finding at care @ home options and devising a plan to pay for them, please contact us by calling 724.942.6200 or by visiting our website at PittsburghElderLaw.com.

The coronavirus pandemic has had a devastating impact on the elderly, particularly those in nursing homes and other long-term care facilities. This has raised questions about how the virus has influenced the costs and provision of long-term care insurance, which covers care in facilities and sometimes at home as well. 

If you have a long-term care insurance policy, you may wonder how it is affected by the pandemic. If you don’t have a policy, you may wonder if the pandemic will make it more difficult to get one. An article by US News and World Report, examines issues with long-term care insurance that have arisen in the last few months, including the following:

  • Qualifying for insurance. It is already more difficult to qualify for long-term care insurance the older you get. Because older individuals are at a higher risk for coronavirus, this can affect your long-term care application as well. Some insurers have been limiting applicants’ ages or putting additional restrictions on applicants who have been in contact with the virus. If you had a positive COVID-19 test, you may have to wait for three to six months before qualifying for insurance. These policies vary by company. 
  • Premiums. Insurers can’t raise rates for customers due to individual circumstances. To raise rates, insurers must obtain approval from the state and raise them for the entire group. However, if you are considered high risk due to exposure to coronavirus, you may not qualify for the best rates when you first apply for long-term care insurance. 
  • Moving out of a nursing home. If you have a policy and want to move out of a nursing home, you will need to check what your policy will pay for. Some policies pay for long-term care in a variety of settings, including home care, but others are more restrictive. On the plus side, you may be able to use your policy to reserve your bed, allowing you to keep your nursing home spot.
  • Home care. If you have a policy that was paying for home care, there may also be changes. Some home care workers are charging more for work during the pandemic, which could exceed your policy coverage. Another change may be to the number of people entering your home. You may want family to provide care, rather than an outside home health care worker. Unfortunately, most long-term care policies don’t pay for family members to provide care. However, if you aren’t using the insurance to pay for care, your coverage may last longer–depending on the policy. 

There are lots of uncertainties regarding long-term care, insurance, and coronavirus. To read the full US News and World Report article about what we do know, click here.

For more information about long-term care insurance, click here

 

The Federal Trade Commission (FTC) is warning residents of long-term care facilities and their families that some facilities may unlawfully require residents who are on Medicaid to sign over their $1,200 pandemic relief checks.

“This is not just a horror story making the rounds. These are actual reports that our friends in the Iowa Attorney General’s Office have been getting—and handling. Other states have seen the same,” writes Lois Greisman, the FTC’s Elder Justice Coordinator, in a May 15 alert.  

The Coronavirus Aid, Relief, and Economic Security (CARES) Act included one-time payments of up to $1,200 to millions of eligible individuals, based on their income. Ordinarily, nursing home and assisted living residents receiving Medicaid benefits must give all their income to the facility, minus a small “personal needs allowance.” However, the economic impact payments that are part of the CARES Act are a tax credit. According to tax law, tax credits don’t count as “resources” for federal benefit programs like Medicaid. The money belongs to the resident, not the facility. 

The FTC says that if a loved one lives in a nursing facility and you’re not sure what happened to their payment, talk with them soon.  If the facility took the payment already, get in touch with your state attorney general and ask them to help you get it back, and then tell the FTC at ftc.gov/complaint.

For the FTC's alert to consumers, click here.

For the agency’s companion alert to businesses, titled “Nursing homes and assisted living facilities: Hands off residents’ stimulus checks,” click here.

For a fact sheet from the National Center on Law & Elder Rights (NCLER) titled “Nursing Home Residents, Medicaid, and Stimulus Checks: What You Need to Know,” click here.

For an NCLER fact sheet for those receiving Medicaid in assisted living facilities or in the community, click here.

 

 

The closure of Social Security offices has caused problems and worries for recently unemployed seniors who need to apply for Medicare after losing their employer coverage. In response, the federal government has announced that seniors affected by the crisis have additional time to enroll in Medicare or change plans.

With millions of people out of work and losing their employer health insurance due to the coronavirus pandemic, the need for Medicare coverage is critical. While it is possible for some seniors to apply for Medicare online, others need to provide more information, including individuals who did not sign up for Medicare Part B initially because they had health insurance through an employer. Seniors who are applying for Medicare Part B after losing their job need to provide proof of their employer policy along with their Medicare application to ensure they aren’t subject to substantial penalties. With Social Security offices closed, Medicare applicants may have difficulty figuring out how to submit the necessary information or getting answers to their questions about their application. 

The Centers for Medicare and Medicaid Services (CMS) has announced changes to Medicare enrollment periods to help seniors affected by the coronavirus pandemic. Those who missed their opportunity to enroll in Medicare will have additional time to apply. CMS is providing “equitable relief” to seniors who:

  • were in their Initial Enrollment Period (IEP), General Enrollment Period (GEP), or Special Enrollment Period (SEP) between March 17, 2020, and June 17, 2020; and
  • did not submit an enrollment request to the Social Security Administration (SSA).

Seniors have until June 17, 2020, to submit an application. Applications can be submitted via fax to 1-833-914-2016 or mailed to the local SSA field office. Although SSA offices are closed for in-person service, offices are still processing applications received by mail. For the SSA’s Social Security Office Locator, go here: https://secure.ssa.gov/ICON/main.jsp

For questions and answers on how to submit a Medicare application and what information is needed, click here.

In addition, CMS has announced an SEP for people to make changes to their Medicare Advantage and prescription drug plans if they missed the open enrollment period or a special enrollment period due to the coronavirus pandemic. The SEP is available until July 13, 2020. 

For more information from CMS, click here

The centerpiece of the $2 trillion Coronavirus Aid, Relief, and Economic Security (CARES) Act, signed into law March 27, 2020, is its one-time $1,200 payments to millions of eligible individuals. When can you expect your payment and how much will it be? The answer to the first question has been changing on an almost daily basis, but finally seems to have come into focus.  Here’s the latest word.

How Much Will You Receive, If Anything?

Under the bill, one-time checks in the amount of $1,200 will go to individuals ($2,400 for couples who filed joint taxes) who earned less than $75,000 ($150,000 for joint filers) on their most recent tax returns, which is either the person’s 2018 or 2019 returns, depending on if they have already filed for this year. Individuals earning up to $99,000 ($198,000 for joint filers) will receive smaller relief checks. Families are entitled to an additional $500 per child under age 17 in the household. The bill also increases weekly unemployment payments by $600 per week for four months.

When Can You Expect the Money?

Those people for whom the Internal Revenue Service (IRS) has direct deposit information will receive their relief money quickest. The first wave of direct deposits went out on April 11, starting with low- and middle-income earners. How long it takes for the funds to hit your account depends on how long it takes your bank to process direct deposits.  

What If the IRS Doesn’t Have Direct Deposit Information for You?

The IRS has direct deposit information for only a minority of relief payment recipients. Those who don’t have deposit information on file have two options: they can wait for their paper check to arrive – which could take a long time – or they can enter their direct deposit information using a new portal the IRS just set up.

Those who don’t provide their bank information to the IRS can expect to receive paper checks, which may take up to 20 weeks to arrive. In other words, some needing quick financial relief may not get their money until September. The IRS is expected to begin issuing paper checks on April 20, with about 5 million checks mailed per week, although the checks may be further delayed because the Treasury Department has ordered that President Trump's name appear on them. Checks will be prioritized to reach low-income earners first. 

If you filed a tax return, your check will be issued automatically to the address the IRS has on file for you and you don’t have to do anything to get it. If you haven’t filed a tax return this year, you should do so as soon as possible so you can receive any relief payment coming to you.

What About Those Who Don’t File Tax Returns?

Initially, the IRS declared that it would have to have a tax return on file for anyone receiving a relief payment.  Many low-income people, however, do not file tax returns because they simultaneously earn too little and lack sufficient employment history to be eligible for a refund. This population includes some of the most vulnerable to the coronavirus — the elderly and people with disabilities. It is estimated that more than 15 million Social Security beneficiaries did not file tax returns last year. 

After protests from AARP, lawmakers, seniors, and other advocacy groups, the IRS reversed course and said that Social Security retirement and disability recipients, some veterans, and many others who don’t file tax returns would automatically receive their checks using information the IRS gleans from Form 1099.  However, that still left plenty of people who don’t receive 1099s – including recipients of Supplemental Security Income (SSI) and veterans disability compensation — out to dry because they don’t receive 1099 forms. A few days later, the IRS announced its new non-filers portal, where recipients can enter pertinent information to receive their checks, and on April 15 the Department of the Treasury announced that SSI recipients will have the  $1,200 emergency COVID-19 relief checks automatically deposited in their bank accounts just as they would normally receive their SSI benefit. . 

According a Social Security Administration notice issued on April 10, “people who receive Social Security retirement, survivors, or disability insurance benefits and who did not file a tax return for 2018 or 2019 and who have qualifying children under age 17 should now go to the IRS’s webpage to enter their information instead of waiting for their automatic $1,200 Economic Impact Payment.  By taking proactive steps to enter information on the IRS website about them and their qualifying children, they will also receive the $500 per dependent child payment in addition to their $1,200 individual payment.  If Social Security beneficiaries in this group do not provide their information to the IRS soon, they will have to wait to receive their $500 per qualifying child.”

What About Those Who Lack Internet Access?

Not everyone, especially low-income people, has access to a computer and the Internet, and so won’t be able to fill out the form on the IRS portal. The IRS has not yet announced a solution for these people.

You Can Check Your Relief Payment’s Status

On April 17, the IRS launched a “Get My Payment” Web tool where relief payment recipients can check the status of their payment and when it is expected to arrive via direct deposit or mail. If you filed a tax return in 2018 or 2019 and didn’t sign up to receive a refund via direct deposit (or didn’t receive a refund at all), you’ll be able to provide your bank information to the IRS using this Web tool, in addition to the non-filers portal the agency previously set up.

 

 

 

 

 

With the coronavirus pandemic hitting nursing homes and assisted living facilities especially hard, families are wondering whether they should bring their parents or other loved ones home. It is a tough decision with no easy answers.

The number of coronavirus cases in nursing homes and assisted living facilities across the country continues to grow. A Washington state nursing home was one of the first clusters of coronavirus reported in the United States, with at least 37 deaths associated with the facility.  The State Reporting of Cases and Deaths Due to COVID-19 in Long-Term Care Facilities continues to indicate a steady rise in coronavirus deaths in long-term care facilities. Their data collection effort finds that in the 23 states that publicly report death data as of April 23, 2020, there have been over 10,000 reported deaths due to COVID-19 in long-term care facilities (including residents and staff), representing 27% of deaths due to COVID-19 in those states.

In an effort to contain the virus’s spread, most long-term care facilities are limiting or excluding outside visitors, making it hard to check on loved ones. Social activities within the facility may also be cancelled, leading to social isolation for residents. In addition, long-term care facilities face staffing shortages even in the best of times. With the virus affecting staff as well as residents, facilities are having trouble providing needed care. Assisted living facilities, which are not heavily regulated, may have greater trouble containing the virus than nursing homes because their staff is not necessarily medically trained.

With this in mind, many families are considering bringing their loved ones home. A Harvard epidemiologist is warning that nursing homes are not the best place to house the vulnerable elderly at this time. And a local judge in Dallas has recommended that families remove their loved ones from infected facilities. Before taking this extreme step, however, you need to consider the following questions:

  • Is your family able to provide the care that your loved one needs? Some patients require help with eating, dressing, medication, and going to the bathroom. You need to consider whether you can adequately provide that care at home. In addition to your loved one’s practical needs, you need to think about your physical and emotional stamina. Also, is your house set up to safely accommodate your family member? Are there a lot of stairs? Does the bathroom have rails? If your loved one has dementia, there may be other considerations to take into account.
  • How well can you prevent infection? Will you be better able to prevent infection than a nursing home? If your entire household is homebound, you may be in a good position to prevent bringing home the virus. However, if one or more members of your household is working outside of the home, you will have to take extra precautions to make sure you don’t bring the virus to your loved one. Are you taking the necessary precautions to keep your house and yourself disinfected?
  • Will the resident be allowed to return to the facility when the threat of the virus has abated? If you take your family member out of the nursing home or assisted living facility, the facility may not let your family member back in right away. You should check with the facility to determine if your loved one will be able to return.

Bringing a family member home is a hard decision and it depends on the individual circumstances of each family. For more on the considerations involved, click here and here.