Sunday, September 2, 2012

Đời dưỡng lão

Đời dưỡng lão
Hà Xuân Thụ

Chi phí rất tốn kém ở viện dưỡng lão làm con cái Mỹ phải bỏ rơi cha mẹ vì trong bài đính kèm có 2 câu quan trọng in chữ đỏ có nghĩa rằng nhà cửa và trương mục tiết kiệm (saving account) đều sẽ bị mất sạch:

1.- Because they need the federal money, most states will now place a lien on a Medicaid patient's house.

2 .- Someone has to pay the costs of a nursing home if your father requires one.

Licensure and nursing homes Cost

The Ohio Department of Health licenses and inspects nursing homes and residential care facilities. Also, if a nursing home is certified for Medicare or Medicaid, they must meet federal certification standards in addition to state requirements.

Costs for long term care vary according to the location and type of facility and services offered. Statewide, the average cost of a nursing home is more than $5,000 per month. The U.S. Department of Health and Human Services's National Clearinghouse for Long-term Care has a wealth of information about costs of long term care by state.

Can a Nursing Home Take Your House?

One of the biggest fears seniors and their families have is,"Will the nursing home take my house if I need nursing home care?"
There are so many fears, so many questions, and so much mis-information about what could happen to the family home if a senior has to apply for Medicaid assistance. We aren't lawyers here, so the first thing we always suggest is a consultation with a lawyer in your state who specializes in these kinds of questions.

That being said up front, this is how things usually work when we're talking about a senior's home and Medicaid:

Your aging parent's house is what Medicaid calls an "exempt asset." This means that, with the exception of very high value houses, when someone applies for Medicaid assistance with nursing home care, the value of the home is not counted as an "asset."

If there is a husband or wife who will continue to live in the home, then that is the end of that and no one need worry about the home. It continues to be protected. If a relative has been living in the home for at least a year (check with your individual state for the exact time requirement) and caring for the person going into the nursing home, they may also continue to live there indefinitely without worry.

What happens to the house when a senior lives alone and needs to apply for Medicaid benefits is a little more complicated.

The nursing home certainly does not want the house. They are in the business of providing nursing care to people who need it. They don't want, and have no right to, the real estate. So the nursing home will not take the house. They just want to be paid for the care they provide.

Medicaid is in the "business" of providing financial help to people who need to pay their nursing home for care. The federal government contributes to state Medicaid funds. In order to make their Medicaid dollars go as far as possible, they have mandated that every state taking money from the federal government must stretch the available money by trying to recoup what dollars they can.

So, because they need the federal money, most states will now place a lien on a Medicaid patient's house. When the house is sold, the state will claim the amount they contributed for nursing home care from the proceeds. The heirs receive the balance.

If family members want to keep the house, they have the option of purchasing the house at fair market value (no, you cannot buy the house for $1). The money from this purchase would then be used by the seller, the nursing home patient, to pay for his or her care.

Many families get bad advice about "gifting" the older person's house to an adult child. It can be done, but exposes the senior to several serious risks. If the senior needs nursing home care within five years of making the gift, he or she can be denied Medicaid benefits.

If the adult child were to be divorced, be sued, go bankrupt, or just have a serious disagreement with the parent, there is a great risk that the house could be lost forever and the older person would no longer have either a place to live nor a valuable asset.

If you have a single elderly person going into care, make it a point to visit with a highly trained Medicaid law specialist before you make any decisions about what to do with the house. While you may not be able to completely avoid some financial penalties, a good attorney can almost always save you and your parent from Medicaid liens against the family home if that's your goal.

Can I prevent nursing home costs from wiping out my Dad’s savings?

Someone has to pay the costs of a nursing home if your father requires one. One option is for your father to purchase long-term care insurance that will cover many nursing home costs for a specified period of time. If your father doesn’t have insurance and he has the assets to pay for a nursing home, then he has to pay those costs until his assets are depleted to a certain level. (This level includes provisions for a spouse.) When his assets are depleted, he will be eligible for government benefits to pay those costs instead.

Your father can’t avoid this “spend-down” requirement by giving his savings to you or by making any kind of transfer of assets at less than market value. He can’t buy a house at twice its market value, for example, in order to transfer funds to a relative. If he does transfer his savings and then needs to enter a nursing home within 5 years after the transfer, the federal government will refuse to pay nursing home costs for the period the money he gave away would have covered. For example, if his estimated nursing home costs are $3,000 per month, and he gave you $150,000, he would be ineligible for benefits for 50 months after the date he moves in the nursing home.

Some people need to enter a nursing home for a temporary period and are then able to resume a more normal life. For them the spend-down requirement can be a burden, since they have few assets left to live on after they leave the nursing home.

There may be ways your father’s savings could be invested or placed in a
Trust or annuity that would make it not count as income for purposes of government benefits. For example, if the money came to your father monthly in a form of payment that did not count as income for government benefits or was below the amount allowed and if your father did not have access to the full amount, he might preserve his savings in the form of monthly income and still qualify for benefits. Your father should get legal advice from a competent attorney on what is legal and what is not legal in this situation, since mistakes can have devastating results.

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