What is a CCRC and How Does it Work? Part 1: Understanding CCRCs

In this three-part blog series, attorney Kelly Shovelin of Four Pillars Law Firm discusses Continuing Care Retirement Communities (CCRCs): What are CCRCs?  How do they work? How do you choose the right CCRC for your needs?

Learn the answers to these questions and more as she covers Understanding CCRCs, Paying for a CCRC, and Choosing a CCRC.

Understanding CCRCs

CCRCs (Continuing Care Retirement Communities) offer an entire residential continuum, from independent housing to assisted living to round-the-clock skilled nursing facility services, under one “roof”.  In most circumstances, residents pay an entry fee and an adjustable monthly rent in return for the guarantee of care for the rest of their lives.

Because CCRCs maintain an assortment of on-site medical and social services and facilities, residents can enter the community while still relatively healthy and then move on to more intensive care as it becomes necessary.

Nursing care is often located within the CCRC or at a related facility nearby. In addition to health care services, CCRCs also typically provide meals, housekeeping, maintenance, transportation, social activities, and security. Communities range in size from about 100 to 500 living units.

CCRCs are so diverse in their offerings and personalities that the saying in the industry is that “If you’ve seen one CCRC, you’ve seen one CCRC.”  The physical plans of CCRCs run the gamut from urban high-rises to garden apartments to cottage-style cluster homes or single-family homes. Some CCRCs provide units that are designed for people with special medical conditions, such as Alzheimer’s disease.

Most importantly, CCRCs guarantee a life-long place to live. Assisted living and even skilled nursing facilities make no such guarantees.  In fact, assisted living and skilled nursing facilities may ask you to leave if they believe they cannot provide the care you need.  That said, virtually no CCRC will guarantee an individual entry into the skilled nursing facility that is a part of the CCRC.  If the CCRC nursing facility is at full capacity (by either other residents or non-residents), the CCRC may place an ailing resident in another nursing facility in the community, in an effort to ensure the resident receives the level of care needed.

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Red Tape of Long Term Care Insurance Claims

So, you’ve done your homework and due diligence and decided that purchasing long term care insurance is an appropriate investment . . . but what happens when you actually need to file a claim and start using it?

Well, it’s rarely as simple as placing one brief call to the insurance company.  As with all health insurance, you have to prove that your need exists for the long term care and that the care you are receiving is appropriate for your health condition.  This may seem easy enough; however, it rarely is, especially when you are suffering.  There can be just as much “red tape” as anything that you have ever encountered before in your life.

To get an idea of what a potentially arduous process it is to file a claim with a long term care insurance company, as well as how crucial the assistance of family members may be in such a process, click here.

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Buying Long Term Care Insurance? Listen Up!

More and more people are becoming aware of the cost of health care as they age, including the potentially disastrous cost of long term care.

In fact, according to the 2013 Retirement Confidence Survey, paying for long term care has become a top worry among the working population.  Chances are many of these same people have seen personally how their parents’ savings was exhausted while paying for long term care needs.  Sadly, the long term care insurance industry is one of the most troubled parts of our healthcare economy.

To learn more about the troubles facing the industry and some buying tips to hopefully protect you in your search for long term care insurance, click here.

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Will you lose Medicare or Medicaid if you Leave a Facility to Visit Family?

Reunions, graduations, birthdays, and holidays: Whatever the occasion, nursing home residents don’t want to miss out on family gatherings, but may be afraid that they will lose Medicare or Medicaid coverage if they leave the nursing home.

In most cases, Medicare recipients can leave for a day or two, although the nursing home may bill them in order to hold their beds. Medicaid recipients will need to check with their state.

Medicare’s coverage of nursing home care is quite limited and it only covers “skilled care” – i.e., treatment provided by a doctor or nurse. Coverage can stop if a patient is no longer benefitting from this skilled care.

However, the Medicare policy manual states that a short leave of absence to attend a family occasion is not, by itself, evidence that the resident no longer needs to be in the nursing home. The manual also states that staff should not tell a resident that leaving the facility will cause coverage to lapse.

If a resident leaves and returns by midnight the same day, the nursing home can bill Medicare for the day. However, if the resident is gone overnight, Medicare will not compensate the nursing home for the time missed. If the resident wants to leave for a few days, he or she should check with the nursing home to make sure the bed can be held. The nursing home may charge the resident a bed-hold fee in order to keep the space available.

If a Medicaid recipient leaves a nursing home to visit family, it is called “therapeutic leave.” State laws regarding therapeutic leave vary widely. Some states will pay to hold a bed for as long as 30 days a year, while others pay nothing at all for such leave. Each nursing home is required to provide residents with information about their bed-hold policy before the resident leaves the facility.

In addition, if a Medicaid recipient is absent longer than the nursing home’s policy allows, federal law requires the nursing home to readmit the recipient to the first available room.

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Have you Named your Life Insurance Beneficiaries?

In financial planning, one of the first things young parents do is buy life insurance to ensure their family is properly taken care of, should something happen to one of the parents.  After all, who doesn’t want to take care of their family?

However, when making that investment, you need to make sure that you properly name your beneficiaries on the policy as well.  It may be one thing to name your spouse as primary beneficiary, but naming your minor children as contingent beneficiaries could be a costly mistake.  Moreover, this is only one potential mistake that may be unwittingly made.

To learn more about exactly what mistakes may be made in naming life insurance beneficiaries and how to ensure you don’t fall victim, click here.

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Disabled Military Child Protection Act

The Disabled Military Child Protection Act has been introduced by Senator Kay Hagan (D-NC) (S.1076) and Congressman Jim Moran (D-VA) (H.R.4329) in an effort to provide for the payment of monthly annuities under the Survivor Benefit Plan to a supplemental needs trust for a veteran’s disabled dependent child.

Currently, under the Survivor Benefit Plan, a veteran may set aside up to 55% of his/her monthly retirement pay to provide for family members upon his/her passing.  However, these benefits can adversely affect disabled family members’ Medicaid and Social Security Disability Insurance assistance.

This Bill has been introduced in an effort to prevent such from happening by payment of the Survivor Benefit Plan stipend into a special needs trust for the benefit of the disabled family member beneficiary.

To learn more, click here.

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Bill Introduced to Allow Individuals with Disabilities to Create own Trusts

Rep. Glenn Thompson (R-Pa.) introduced the Special Needs Trust Fairness Act of 2013 on May 23, 2013 (H.R. 2123).

According to a press release from the National Academy of Elder Law Attorneys (NAELA), the bill would allow people with disabilities to create first-party special needs trusts to hold their assets without interfering with their access to Supplemental Security Income (SSI) and Medicaid.

The bill addresses a quirk in the current law defining special needs trusts that prevents mentally competent people with disabilities from establishing so-called (d)(4)(A) trusts. As the law stands today, a first-party special needs trust must be created by a parent, grandparent, guardian or court, even if the beneficiary is going to be the person transferring the funds into the trust once it is created.

This restrictive provision, which was likely the result of a drafting error, forces countless trust beneficiaries who don’t have parents or grandparents, or whose parents or grandparents are unwilling or unable to help them, to petition courts to establish trusts when they are perfectly capable of creating the instruments themselves.

According to NAELA’s press release — the text of the bill is not available online at this time and neither Rep. Thompson nor his Democratic co-sponsor, Rep. Frank Pallone (D-N.J.) have any information about the legislation on their Web sites — the bill would amend the Social Security Act to allow beneficiaries to create and fund their own special needs trusts, which, according to NAELA President Gregory S. French, would “maximize client independence and self-determination.”

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Happy Memorial Day!

Happy Memorial Day to everyone!

Whether you’re vacationing, barbecuing, relaxing, or even working….take time to remember the men and women who gave their lives for us.

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“Sole Benefit” Payments Expanded

After much concern and some troubling provisions, the Social Security Administration (SSA) has revised its manual and policies to allow first-party supplemental needs trusts to pay for some expenses previously not considered for the “sole benefit” of the trust beneficiary.

According to the manual, the general rule is that a trust is established for the sole benefit of an individual “if the trust benefits no one but that individual, whether at the time the trust is established or at any time for the remainder of the individual’s life.” However, the revised manual provisions establish two exceptions: (1) third-party payments and (2) administrative expenses.

The new rule states that payments do not violate the sole benefit rule if they are to third parties for goods or services received by the beneficiary, payments of third-party travel expenses “which are necessary in order for the trust beneficiary to obtain medical treatment,” or payments that allow a third party to “visit a trust beneficiary who resides in an institution, nursing home, or other long-term care facility (e.g., group homes and assisted living facilities) or other supported living arrangement in which a non-family member or entity is being paid to provide or oversee the individual’s living arrangement.” However, “[t]he travel must be for the purpose of ensuring the safety and/or medical well-being of the individual.”

In addition, the revised manual clarifies the rule that payment of some administrative expenses upon early termination of the trust or otherwise, including trustee fees, will not violate the sole benefit rule.

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Be Careful Who You Trust

One of the most important decisions you can make is who to entrust as agent over your financial affairs.

Executing a General Durable Power of Attorney authorizing someone to make financial and legal decisions on your behalf is an essential part of anyone’s estate plan.  After all, no one has the authority to pay bills and make financial decisions on your behalf otherwise without court appointment and approval.

Most people prefer to keep their business private and out of the courts by incorporating a Power of Attorney into their estate plan.  This valuable document, however, can also lead to unintended consequences when authority is granted to inappropriate individuals.

For instance, one gentleman granted Power of Attorney to his daughter only to find she later deeded ownership in his home to herself and then proceeded to sue and evict him.  In the hands of trusted individuals, however, the authority conveyed in your Power of Attorney can serve priceless toward your financial protection and autonomy.

To learn more about how the elderly man was forced to raise money in order to buy back his home from his daughter, click here.

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