well.

Good evening.

Thanks so much for tuning in to PBS Fort Wayne and LIFE Ahead.

I'm your host Mark Evans and of course this is a viewer interactive program and you can call us our Texas with your questions.

We love that because that is the main reason why we do this show is because we want the viewer interaction from the public who is watching and of course from our supporters.

So tonight we'll talk about long term care which is very important especially for the older folks.

But even the younger folks need to know about this in case this happens to come up and we'll help you navigate through that process.

And of course right now until December 7th we're going through Medicare enrollment and we want to go ahead and smooth some things over and really define what is correct and what is not and clear up some of those misconceptions when it comes to long term care.

>> So we're going to go ahead and start the program and I want to give you a little notice on the bottom of your screen not to be pointing a bit at the bottom of your screen, a couple of numbers to to pay attention to if you want to call us and ask a question live on the air which we do encourage.

We love that or if you want to call us and we transcribe the question for you.

We have somebody at the phone bank to handle that.

That phone number is on your screen right there and then if you want to Texas you can text us with that number and when you do text your question or comment, please provide at least your first name and town from which your texting so we can say hello to you.

We appreciate that.

So our guest tonight not a stranger to the LIFE Ahead living room is Brian Nugent and he is a elder law attorney and an estate planner.

>> That's correct.

So welcome back.

Thank you, Mark.

I appreciate.

We always appreciate you being here because you seem to just get it.

I don't want to say dumb it down but you make it very clear for people and helps them understand because you know this this whole thing especially with you being a lawyer as you know is a lot of legalese legalese going on and we like to have that cleared up.

>> Of course I'll take that as a compliment.

Thank you.

All right.

Absolutely.

And it's always a pleasure to have you.

So let's go ahead and get started.

I want to kind of build the platform for the show and talk about what long term care actually means like in the world of elder law, the medical industry and Medicare.

>> How is it described so when we talk about long term care we're generally talking about a nursing home stay a memory care unit, stay so something other than assisted living, independent living, typically nursing home or memory care unit stay and we're talking of course as it says long term care what what qualifies for long term care?

>> I mean you're a certain number of weeks or certain number of months.

No, it's that there's a point in your health journey, right?

>> Your journey, your health that it doesn't make sense for you to be alone or or your level of care is to a point that maybe your loved ones aren't able to provide for you or you don't you're not fortunate enough to have a staff that are able to come in and provide assistance to you.

So you're needing to look for alternate housing and something like a nursing home or a memory care unit is a better fit where they have staff onsite dietitians onsite and nurses are there visiting doctors that make rounds, et cetera.

So long term care doesn't necessarily mean chronologically how long that you're there but it could be care that's for an extended period of time as contrasted with maybe a hospital stay or rehabilitation stay which would be for a shorter period of time.

>> And can you have long term care at your own home?

No long term care in the industry is defined as a nursing home.

Stay or a memory care unit stay.

You can receive care in your home.

That's true and that could be you could pay for that privately or through a long term care insurance policy if it has the right language in it you have that paid for through Medicaid or the Veterans Administration but generally in the industry we don't look at a state in your home as long term care and you just set me up for the next question.

Many people believe Medicare will cover long term care for nursing home state.

>> That is not true, right?

That's true.

Medicare does not pay for one stay at a nursing home and I think that that confusion comes from the fact that there is rehabilitation that goes on at a facility that also provides nursing home care or memory care unit stays for the residents.

So someone thinks oh my mother went to the nursing home when she was there for a period of time after a fall or a medical event and then she came back home and that was fully paid for her Medicare paid for that well, she most likely was there for a rehabilitation stay after a hospital stay.

>> I had a discharge and then went to rehab and it just happens to be that rehab is under the same roof as a nursing home.

So folks oftentimes get confused with thinking I don't need to worry about paying for that stay as I'm aging Medicare, I have Medicare.

Medicare will pay for that for me so that comes up often and we will talk about how long term care can be paid for sure.

>> But you know, we often do hear that long term care is expensive and more than people can actually budget for in some cases.

>> What is the average cost of a nursing home in our area and why is this an issue?

Yeah, in our area we're actually higher.

Allen County is for some reason higher for the state between one thirty one thirty six hundred and thirty two hundred and thirty six thousand a year statewide you're maybe one hundred and six to one hundred and twenty thousand per year but in our area for some reason or a little bit higher than state averages so we're talking well in excess of one hundred thousand dollars per year for memory care unit stay or nursing home units stay or rather care unit or nursing home stay.

>> So let's go back to Medicaid.

Yeah.

How much will they take or how much will they offer for long term care?

>> So Medicaid which is different than Medicare so Medicaid will pay for one stay at a nursing home or a memory care unit so long as that facility accepts Medicaid and a majority do so around sixty five percent of the residents in Indiana that are in nursing homes memory care units have their state paid for by Medicaid so it will pay for all of it minus any income that you have income from a source like Social Security or a pension.

So in order for Medicaid though to trigger to pay for your stay, your income has to be in certain brackets and your assets have to be in certain brackets.

There are ways to protect assets there are ways to reduce your income so that Medicaid would pay for your stay.

But generally Medicaid will pay for one hundred percent of it.

>> OK, yeah.

So let me ask you this the financial requirements I mean they're not just going to develop Medicaid help to everybody.

>> Aren't there some financial requirements for that?

>> So the first thing that they that Medicaid will look at is your income.

How much money are you making annually and then they amortize that over 12 months.

So how much money is that that you're making and there's a threshold for how much money you can make and if your income is too high to qualify Indiana permit something called a qualified income trust so you can sometimes called Miller Trust so a qualified income trust Miller trusts those trusts are used to reduce one's income such that you would qualify for Medicaid and how they work is your Social Security, your pension etc.

goes into your checking account like it always does and then from that checking account it's transferred to a checking account and the name of your qualified income trust.

So my last name is Nugent so I might call that Nugent Qualified Income Trust.

So my income goes to my checking account first.

It's then transferred from my checking account to the Qualified Income Trust Checking account within the same month in which it was earned and then it goes from that quality that Miller checking account to the nursing home to pay for my care and the idea behind those qualified income trust those Miller trusts is that if you pass away and there's money left inside that trust that wasn't used to pay for your care, that money then goes to the state to reimburse the state of Indiana for any expenses incurred on your behalf and paying for your state facility.

So the rationale is yes, there are caps on how much money you can make before you can qualify for Medicaid to pay for your long term stay.

However, the state has permitted us to use qualified income trusts.

Miller trusts that if we take our income out of our after goes into our checking account we move into a qualified income trust checking account and to the facility.

Medicaid will say we're going to recognize you as having a lower income so you can qualify for Medicaid.

>> OK, so is it legal to protect your assets or is that considered hiding them?

>> Great question.

Sometimes I'll hear people say, you know, we want to hide our money from the nursing home or you know, how can we hide it there is no hiding of your money.

So I was answering your question before Mark.

I was talking about that income and how we protect rather the state permits us to artificially suppress or reduce our income by running it through that qualified income trust.

The second qualifier for getting Medicaid as far as economics are concerned are a look at your assets.

How much money do you have in your name?

So in order to get Medicaid in Indiana you have to have two thousand dollars or less in your name.

>> So to your question mark, is there a means of sheltering assets in order to get your your assets below that two thousand dollar figure and qualify for Medicaid?

And the answer is yes.

And the best analogy that I can provide for that is during tax season when you're filing your tax return, your state and your federal tax returns, there are deductions you're permitted to take and there are techniques that you're permitted to use to assist in reducing your tax liability.

And that's the best analogy I can provide for when one's wanting to protect their assets appropriately.

There's no hiding going on.

Everything that's done would have to be disclosed to Medicaid.

It would be inappropriate not to disclose it to Medicaid.

And I'll also tell you if you feel like you're not going to disclose an account that you own, we have a checking account or an investment somewhere and I'm not going to bring that up but I'm still going to apply for Medicaid benefits.

The state has the ability to see if there are any accounts in your name and how much money is and those accounts when you are applying for Medicaid so there is no hiding of money that that is is never an appropriate approach to trying to shelter your assets.

You can't gift your money away hoping that I'll give it to my kids on day one and I'll apply to the nursing home or I'll move to the nursing home and apply for Medicaid the next day.

That doesn't work either.

Gifts aren't looked upon very favorably by Medicaid.

Medicaid will say you've given away X dollars and they'll divide that by a number that changes every year.

So for purposes of this discussion let's say that in the year twenty twenty six that figure is eight thousand dollars.

So if you gave away eight thousand but when you're applying for Medicaid, if you've given away eight thousand dollars within the past five years, six months, we divide it by that figure of eight thousand and the answer is one right eight thousand divided by eight thousand is one.

And so Medicaid says I won't pay for your stay for a month.

>> So that's the penalty for having made a gift within the past six months.

>> So we it would be very dangerous to think that you're going to gift your way into protecting your assets.

That's something to be for folks to be cautioned about not to make gifts to your kids or gifts to this person or that person and then think you're going to be applying for Medicaid without a consequence.

>> Well, doesn't that kind of tie in with a spend down so because you hear that once in a while when somebody is going to spend it care, I got to do spend down was that well?

>> So it is true you could make the decision that I'm going to spend all of my money down to two thousand or less and then apply for Medicaid.

OK, so if you were taking that approach we would not be sheltering any of your assets.

You've made the decision that I'm going to spend everything that I have and then when I have no funds left I will then apply for Medicaid.

But what I was getting at for is is there a way in which we can protect assets and not spend ourselves down to two thousand dollars or less and there are means of accomplishing that that are approved and sanctioned by SSA Medicaid within the state of Indiana.

So there's no funny business that's going on.

Not at all.

OK, and I think you touched on this just a question ago or so the five year look back period I stumbled across that research and sent me so what when you apply for Medicaid, one of the questions that's asked of you is in the last five years in the last 60 months, have you given anything away so that five years is a look back period?

So Medicaid when you apply is going to look back five years and say within the past 60 months have you given anything away for which you got nothing in return or you sold your your home for a dollar and the home was worth significantly more than that?

>> That's considered a gift if you give money to your children that's considered a gift.

>> If you if you pay someone to come into your home and they provide care for you and you do it without an agreement in place and without that caregiver paying taxes on that money, that's a gift.

>> So what Medicaid does is they look back five years and they say what money if any have you given away without getting something in return or of equivalent value in return if you have given something away within the past five years will total of that figure up and we'll divide it by the then current deviser.

So that's the it's actually higher but it's easier to to for me in my brain to calculate round numbers.

So if we say that that figure eight thousand dollars that's the divisor.

So in the past five years if I give given away eighty thousand so in the last six months I've given away eighty thousand dollars I then apply for Medicaid we take that eighty thousand dollars that you've given away within the last six months.

We divide it by the eight thousand dollars the answer is ten.

All right.

So I've given away eighty thousand dollars the divisor that year is eight thousand.

>> The answer is ten.

So if you're applying for Medicaid Medicaid's responses for the next ten months we won't provide care.

We won't provide payment rather for your care.

So if your cost of care is ten thousand dollars per month you've given away eighty thousand dollars there's a penalty period.

So for a period of ten months Medicaid will not pay for your care.

Someone has to come up with one hundred thousand dollars to pay for your care.

So be very cautious about making gifts.

It can create a much larger consequence than you were thinking about.

>> I'm so glad that was brought up.

I think we have a call or a text from someone about a very long term care question so we'll go ahead and see what that is.

>> With Veterans Day coming, what are the options for veterans for long term care either through the VA or through state veteran homes?

Does it take a specific VA disability rating to be considered?

Sure.

So great question.

Yes, the VA will pay for those veterans that are one hundred percent disabled.

The VA will pay for one stay at a VA either at a VA hospital I think there's only one in Indiana and Marian or with nursing homes I said VA hospital, VA nursing home or the VA has contracts with various nursing homes.

They're nursing homes here in L.A.

County and DeKalb County and various counties that have contracts with the VA.

So if you're a disabled hundred percent disabled veteran, the VA will pay for your stay in a nursing home which is an incredible benefit and a benefit to our our veterans.

They've earned it and they're entitled to it.

But let me visit about the VA.

Just call if you don't mind me going on a little bit more.

>> I do encourage all of our veterans to have a disability assessment.

>> So you may think that gosh yeah, I'm hard of hearing but other people are hard of hearing.

Well, have the VA make an assessment as to whether or not that lot that hearing loss is related to your service if you have things like incontinence diagnosis or other medical conditions, perhaps you're not ambulating as well as you once did have a disability assessment done.

You're entitled if the VA determines that it's service connected you're entitled to a pension from the VA as a result of those are a disability payment from the VA as a result of those concerns that you have.

And I like to tell folks when you're having that assessment done by the VA don't be a hero.

Let them know what your worst day was when you're having that assessment done, you deserve those disability payments.

You've earned those disability payments and and without a doubt you're entitled to them.

One other thing about the VA that's a benefit that a lot of folks don't know about when I speak with veterans is that simply as you having served as a veteran you're entitled to receive attendant care and your home some homemaker services in your home as well.

>> So unrelated to your assets, unrelated to your income.

The VA has a benefit for its veterans that the VA will contract with outside agencies to provide care in your home.

So we started out the questioning tonight about long term care.

But before we get to that facility that long term care sometimes a little bit of help in your home two hours a week, six hours a week, 10 hours a week, 20 hours a week that may allow you to remain in your home significantly longer.

So veterans that are listening I would encourage them to speak with your VSOE veteran service officer have a disability assessment done at the VA hospital and see if you qualify for those disability payments.

There's also a program through the VA called Aid and Attendance Now Aid and Attendance is a program that benefits veterans.

It can benefit spouses of veterans as well but that's more needs based when I say needs based, I mean they do take a look at your assets.

They do take a look at your income and they also take a look at physically do you need assistance?

Are you in need of assistance with those activities of daily living that I was referencing earlier using the restroom, taking a shower, preparing a meal, those types of things.

So there are several programs for the VA one the VA will pay for those vets that are 100 percent disabled.

It will pay for their stay disability for veterans and we'll also provide direct the VA has direct contracts with providers that will come into your home and provide care for you.

And if it's a more of a needs based situation where we have low income or lower assets, the VA has a program called In Attendance that could benefit both the veteran and the veteran spouse and we're talking about a more mature group for that type of care.

There are other benefits to the VA as well as any number of benefits I'm specifically talking about for some more mature veterans we've got to take care of our veterans.

So let's talk about irrevocable trust.

>> You often hear about putting home or savings into one of those and how does that protect assets?

Great question.

So remember before you were asking me about the five years and the look back period et cetera right.

>> So you are if we create a type of a trust and irrevocable trust that's established five years or more before you need the care and we fund that trust with assets like your home investments, anything other than qualified money.

When I say qualified money I mean IRAs, 401.

KS, those types of things, those types of assets, those qualified moneys go into the trust.

But if we have a brokerage account or you have a savings account, your home secondary property, your farm or you have farmers that maybe have several acres of ground and they're concerned about losing that ground should you have a nursing home stay there are trusts that you can create so long as they're in place for five years or more that Medicaid doesn't ask about those investments, those assets that were put into that trust.

But there are strings that are attached with that there is some level of a loss of control that goes along with those trusts but it's protected so we're not giving it to a child and then maybe a child has they passed away unexpectedly and you lose your money through their estate.

However they've set that they have an illness, some type of a disease.

>> You don't lose it to your child's illness or death.

Your child has debt that you didn't know about and a creditor sues so those trust can be very, very useful tool to protect assets and I as I say, five years or more in advance oftentimes I'll get the question well what's the right age to do those?

>> So average age of a nursing home in Michigan is around eighty two .

So early seventies, mid seventies we need those five years to have run before you have that average age of nursing home.

But there are folks that are younger right.

Than 70s and they've maybe they have a series of health issues.

Maybe they have an early onset dementia.

Maybe they've had cancer bouts or heart issues.

So it's not locked in that it's always in your 70s but very generally that's when I'd like to see those establish OK and I want to make sure we get this question and we've only got a couple of minutes left.

>> But if one spouse goes into a nursing home, does the healthy spouse at home have to pay for this care?

Well, Medicaid looks at all of your assets that you have.

So if one spouse is in the facility and another spouse is in the community, Medicaid will look at everything that they have collectively you're asking kind of a loaded question is the healthy spouse have to pay for the spouse in the facility their care there is a minimum amount money that the healthy spouse can keep that Medicaid permits you to keep.

>> But if there is a means I was giving you the analogy earlier in tonight's discussion about that the IRS code and taking those breaks to get deductions, et cetera.

There is a means of protecting assets even for the healthy spouse even if they are married and their spouses in the nursing home and oftentimes all of those assets can be protected if done properly .

>> So to answer your question, all of the assets of the couple are looked at.

There are means of protecting those assets for the healthy spouse if if folks available themselves of those.

>> All right.

We only have about 30 seconds left so some take home notes or some notes that people need to really digest and understand No one aging happens plan for it in advance if you can protect assets in advance always best if you're unable to do that, it's never too late to protect assets.

Never assume that you have to run through your life savings.

That doesn't have to happen and the care is the same regardless of how it's being paid for .

>> It's the same care it doesn't change and I would highly recommend talking to an elder law attorney about this when you it's good advice.

>> Yeah, a very good Reinach and thank so many more questions but so little time but we'll pick up where we left off next time but in the meantime you can watch this episode on YouTube as well as the PBS Fort Wayne website and other episodes we've had in the past until next week.

We thank you so much for watching.

Take care