Elder Law Attorney in North Reading 

REPRESENTATION IN ALL ASPECTS OF ELDER LAW INCLUDING NURSING HOME ADMISSION AND MASSHEALTH APPLICATIONS

Roberta A. Schreiber has provided Elder Law services for Seniors and their families for more than thirty years. She works with individuals and families before a medical crisis, planning to protect the family's assets and to provide funds for in-home care and nursing home costs, as well as being available during a medical crisis when difficult decisions must be made very quickly. Roberta works with a network of accountants, financial advisors, social workers, geriatric case managers, and administrators of Nursing Homes and Senior Centers, so that she can help you and your family deal with the practical problems of growing older, as well as the legal issues involved, including:

• Drafting Wills, Powers of Attorney, Health Care Proxies, and Living Wills
• Establishing and funding Revocable and Irrevocable Trusts
• Asset Protection
• Pre-Nuptial and Post-Nuptial Agreements
• Purchasing Long Term Care Insurance
• Admission to Retirement and Senior Communities
• Obtaining a Reverse Mortgage
• Finding and paying for In-home medical care and assisted living facilities
• Assistance with Nursing Home admissions and grievances
• Medicare, and Medicaid (MassHealth) eligibility
• Representation in Medicaid appeals

Planning in advance is the most critical part of Elder Law. The first step is making sure that you have the documents in place that will give trusted family members and friends the ability to care for you, either temporarily, during a medical emergency, or permanently, in the case of a condition such as Alzheimer's Disease. These documents include a Durable Power of Attorney, Health Care Proxy, and Living Will Declaration. In these documents, you name the person who will be responsible for managing your finances and making health care decisions on your behalf in the future, if you are unable to do so. Your instructions can range from simple banking arrangements, to alternate living arrangements in the event of disability, and to the ultimate decision of dying with dignity. With these documents in place, family members will be able to care for you, according to your wishes, if you become incapacitated.

With advance planning, the family members and friends chosen by you will be able to act immediately in a medical crisis, without having to go through the Probate Court process of being appointed as your legal Guardian. In addition to these basic documents Seniors should have a Will in place, to ensure that their estate will be managed by the family members or friends chosen by them and to make sure that their assets will be distributed in accordance with their wishes. If probate avoidance is a priority, establishing and funding a Trust is appropriate. If you wish to retain complete control over the trust assets, a Revocable Trust is the best choice. If your primary goal is to protect your assets from future nursing home costs, establishing and funding an Irrevocable Trust can accomplish this goal.

Seniors are living longer and as a result, are entering into second and third marriages in their later years. At this stage in their lives, both spouses usually have their own sources of income, their own homes, and their own investments. Many people do not understand the legal consequences of adding a new spouse's name to the deed to their home and their bank accounts, or naming their spouse as the primary beneficiary of their retirement accounts and life insurance policies. If your spouse outlives you, he or she will be free to do whatever they wish with the real estate, bank accounts, and the funds that they collect from the retirement accounts and life insurance policies. They may honor your wishes and leave these assets to your children by a prior marriage, but they may not.

If you wish to provide for your current spouse without disinheriting your children by a prior marriage, the better plan is to establish a trust to hold title to your assets. The trust assets may be used for your benefit and your spouse's benefit while both of you are alive. After your death, some or all of the trust assets may be used to support your current spouse, and after his or her death, the remaining trust assets will be distributed to your children. Another good option is the Pre-nuptial Agreement. A well-drafted agreement, will avoid conflicts during the marriage about living arrangements, sharing expenses and bank accounts, and will ensure that children by a prior marriage will not be disinherited. The parties agree how they will share expenses, where they will live, what happens when one spouse sells their home, how they will provide for each other in the event of divorce or death, and how they will provide for their children. You can enter into a similar agreement, known as a Post-Nuptial Agreement, after you have entered into marriage. For more detailed information about planning after a second or third marriage, see the Article titled "Planning for the Modern Blended Family".

Planning in advance is important, so that you will not have to spend your life savings and sell the family home to pay for nursing home costs. Under the current Medicaid (MassHealth) rules, there is a five year disqualification period for benefits after making a gift or funding an Irrevocable Trust, so you should take these steps while you are still healthy and able to care for yourself. Other planning options include Long Term Care policies (which are expensive), gifting to younger family members, and establishing a Trust to protect your assets. See Roberta's Article titled "Planning for Long Term Care and the Medicaid (MassHealth) Program" for more detailed information about planning options and the financial eligibility requirements for the MassHealth program, which pays for long term nursing home care.

Unfortunately, it is not always possible to plan in advance. In a medical crisis, family members must make difficult decisions under stressful conditions. It may be necessary for a family member to be appointed as a legal Guardian of a spouse or parent through Probate Court proceedings. You may have to find a suitable nursing home or assisted living facility for a spouse, parent, or sibling, within a few days after a hospital admission and figure out how to pay for it. There are many misconceptions about what happens when a family member must be admitted to a nursing home. Contrary to popular opinion, the State does not take your house and your life savings. If the family member who is being admitted to the nursing home is married, there are many planning options that can save the couple's home and life savings. The Medicaid program, which provides benefits to pay for long term nursing home care, is administered in Massachusetts as the MassHealth program.

Under the MassHealth regulations, the "community spouse" may keep the family home and $109,540 of the couple's savings and investments. Although the institutionalized spouse must reduce his or her assets to $2,000 in order to qualify for MassHealth benefits to pay for his or her nursing home care, the excess assets (more than $111,540) may be spent on prepaid burial contracts for both spouses, repairs to the family home, the purchase of new appliances, and other permissible "spenddown" items under the MassHealth regulations. The community spouse may also use the excess funds to purchase an immediate irrevocable annuity that will provide monthly or quarterly income to the community spouse, to supplement his or her other sources of income.

If the MassHealth applicant is single, widowed, or divorced, he or she may transfer title to the family home to a sibling with an equity interest, an adult disabled child, or a "resident caretaker child." These planning options may be utilized at the last minute, but they must be done correctly in order to qualify for MassHealth benefits. For more detailed information about the Medicare and Medicaid (MassHealth) programs and planning options, see Roberta's Articles titled "Planning for Long Term Care and the Medicaid (MassHealth) Program" and "Medicare, Parts A, B, C and D."

Roberta has the experience to help you and your family plan in advance, as well as deal with the unexpected medical crisis. If you would like to schedule an appointment for an initial consultation, please contact us.