Caregivers Solutions Radio Interview with Arden Courts (Transcript)
D. "Rep" DeLoach III, Estate Planning and Board Certified Elder Law Attorney
Marcia Teele, Marketing Director of Arden Courts Memory Care
Marcia Teele: Hi, everyone, and welcome to Caregivers Solutions Info. I'm your host Marcia Teele and I'm so happy that you could join us today. We have another wonderful program for you. This show is actually created for caregivers; caregivers especially that are caring for someone that has some form of dementia, like Alzheimer's or vascular dementia, people that cannot care for themselves any longer. It's not easy, to say the least. And caregivers sometimes get thrown into it, sometimes very quickly and they don't know what to do, and they're learning as they go.
So, this show was created to help caregivers, to help them along that path, that journey, by providing educational information, tips, and advice from experts in all different fields. We have had people that come onto the show to share their stories, their expertise, from elder law attorneys, social workers, geriatric care managers, even caregivers.
But right now I want to talk to caregivers, especially those that maybe haven't planned for the future to take of their loved one financially. It can be a burden, as some of you may know, taking care of someone, because caregivers can't always do it at home, alone, by themselves. And there comes a point in time where they do need assistance, whether it's from family members, neighbors, or hiring a home health company to get private duty aids. But that costs money for that.
Also, sometimes people cannot stay in their homes for lots of reasons. Sometimes the caregivers are overwhelmed, they just can't handle it anymore. And matter of fact, the stress that caregivers feel sometimes makes them not able to be a caregiver, because they end up being sick and not being able to take care of the person that they're supposed to take care of.
So, home is not always the best place to be for the long term. And sometimes that person with the dementia must go and get more help, which would be like an assisted living for memory care. If someone doesn't get into a memory care assisted living and they wait too long, they may have to go into a skilled nursing facility or a nursing home for the long haul.
It doesn't matter what you do and how you do it, it's still gonna cost money out of your pocket. And people wonder all the time, "How can I pay for this?" It just seems like it's getting more and more expensive, and some people obviously have the private funds to pay for that and other people don't. So, caregivers ask me all the time, "What can I do? What resources are available to me to help me pay for the care?"
So today the good news is, we have an expert who's going to be sharing his knowledge to all of you. I'm so excited to have him today. I'm actually at his office in Seminole, Florida. He is a board certified elder law attorney with the firm DeLoach, Hofstra & Cavonis, professional association in Seminole, Florida, estate planning and more.
And so, right now I'd like to bring on with him on the telephone, joining us live is Rep DeLoach. Hi, Rep, are you there?
Rep DeLoach: Yes, I am. Thank you, Marcia.
Marcia Teele: Well, thank you so much for joining us today on the program. I'm very excited to talk with you and have you share your expertise to all the caregivers out there. It is a lot of information that caregivers need to get from all different kinds of disciplines. But I think if they've planned for it, it makes it a little bit easier. And I'm sure that you come across this every single day doing what you do. You have a great reputation in the community, and I know you've helped hundreds and thousands of people over the years. And we're gonna let everybody know how to reach you at the end of this program.
So, we will get the question. There's a burning question that I'd like for you to address. I get it all the time. People say that they need help. First of all, they don't understand sometimes the difference between Medicare and Medicaid, so let's briefly explain that before that.
So, Rep, share with us briefly the difference between Medicare and Medicaid for caregivers, so that they know where they should start.
Rep DeLoach: Yes. The first thing we think about is, most people have never gone through this in their entire life, whether it's for themselves personally or if they're trying to help their loved one. And it's extraordinarily difficult. And you have so many questions to ask and places to go, and as you know, it's difficult to find good answers. And what we always say is you don't know what you don't know. And when you don't know what you don't know, you can't ask the right questions. And when you can't ask the right questions, you certainly can't get the right answers.
And so, they're dealing with their loved one and they're trying to figure out, "What do I do to make sure my loved one gets the right care in the right environment, and how do I pay for it?"
And one of the first things that you think about is, for instance, will Medicare help pay for my loved one's long-term care? Families don't know. We had a family in a couple weeks ago, they said, "Well, jeez, if I got sick, will Medicare send someone out to keep me in my home?"
And again, families don't know the difference between Medicare and Medicaid and all these different things. Well, let's start out with the question that you had, which is Medicare versus Medicaid. And the first thing that we would say is, Medicare is health insurance. And health insurance is there to pay, of course, for your doctor's visits, for your hospital visits, it's there to pay for your durable medical equipment. It's there to pay for a lot of different things, including your prescription and your pharmacy bills.
But health insurance is not long-term care insurance. So, health insurance is just what we described earlier, doctors, hospitals, et cetera, but it has nothing to do with paying for your long-term care. Long-term care of course has to deal with your activities of daily living. And your activities of daily living, generally six activities of daily living, but it's eating, dressing, bathing, grooming, medication management, toileting, and transferring.
And when you as a human being are no longer able to live independently, then you probably need help with one or more of your activities of daily living. And so, Medicare does not help with your activities of daily living, the things that you do as a human being to maintain your own sense of independence.
Medicare is simply health insurance, where Medicaid is a government program, a needs based government program that does a lot of different things, but in particular we think about Medicaid in the long-term care arena. In the long-term care arena, the Medicaid helps pay for your care, whether it's in the nursing home, possibly in the assisted living facility, or even at home. So, Medicaid is a needs based government program that can help pay for your long-term care.
Again, and then just go back to Medicare. Medicare is something that you pay for during your working years, that it's just your health insurance as you reach age 65 or if you become disabled before then.
Marcia Teele: Right. So, I tell families Medicare is pretty much the same all across the United States, but Medicaid is different state to state, depending upon what state you're living in, correct?
Rep DeLoach: Absolutely. Basically, Medicare is of course across all the states, but the Medicaid and Medicare is a partnership that each state implements with certain rules, but they're gonna vary between every single state. So for example, I know the Medicaid rules for long-term care backwards and forward in Florida, but I just have no idea what any other state are. I know Florida, but there are 49 other states and their rules are gonna be different for all 49 of them.
Marcia Teele: Right. So, for our purposes today, we're in Florida. You're a board certified Florida elder law attorney, and we're going to be talking about Medicaid in the State of Florida, just so people understand that. And if we have listeners that are tuning in from other states, then they should go to an elder law attorney in their state to ask more questions about the specific rules and regulations of Medicaid there.
Rep DeLoach: Absolutely. There may be some things that apply, but we wouldn't have any idea, frankly.
Marcia Teele: Exactly.
Rep DeLoach: So, that's where they would go to an elder law attorney in their state if they wanted to have some of this information.
Marcia Teele: Right. Okay, so now we know the difference between Medicare and Medicaid. And you mentioned Medicaid can help pay for someone being in an assisted living or for someone being in a skilled nursing facility, but they're not the same, they're different. Can you explain the difference between the two kinds of Medicaid for long-term care in a facility or a community setting?
Rep DeLoach: Yes. So, what we think about is our social safety net. The social safety net that exists in Florida and the social safety net that exists in the United States. And Medicaid is part of our social safety net. Our society got together and said, "We want to create a system of rules that the neediest people are taken care of." And the people, it takes care of disabled people, it takes care of the elderly as well.
There's a lot of different Medicaid programs, but ultimately there's the long-term care Medicaid system in the State of Florida. And the long-term care system in Florida is a needs based program that will help pay for your long-term care. But the basis of what we think about long-term care in Florida, and this is not just Florida, but will be for other states as well, is that our social safety net is really wonderful to help people stay in the nursing home.
So, you might have heard the term entitlements or entitlement reform in that context, but ultimately Medicaid is an entitlement. And if you qualify for Medicaid financially and follow the various rules that appear, then the State of Florida has more or less, and the federal government has more or less guaranteed you a place in a nursing home that accepts Medicaid.
Marcia Teele: So that you're not homeless when you run out of money and you have no place to live?
Rep DeLoach: That's exactly right. So, if mom or dad is sick and needs nursing home care, and if they run out of money, then Medicaid is gonna be there to pay for their care as part of our social safety net. And so, that's kind of the basis for it, is that, all right what is our social safety net? If any one of us have a stroke or a car accident and we run out of money and we had to be in a nursing home, we follow the rules, then basically our society has guaranteed us a place in a nursing home.
Marcia Teele: So, that was the original, or what I call the traditional type of Medicaid and that's for nursing homes, right? What if somebody doesn't need to be in a nursing home, but they still need long-term care and they're not that sick, but they still need help, so maybe they could go to an assisted living, but they don't have money? So what happens then?
Rep DeLoach: Well, that's where it gets really difficult. So, if we go back to our baseline, is the nursing home, right? So, we have a guaranteed spot in the nursing home if we run out of money and follow the rules, but if we had a room full of 100 people and said, "Raise your hand here if you ever want to end up in the nursing home at the end of your life."
Marcia Teele: I don't think you'd get many takers.
Rep DeLoach: I think that's right. So, no one would raise their hand and say, "I want to end up in the nursing home." And we can understand. I don't want to end up in the nursing home. Marcia, I know you don't want to end up in the nursing home. No one would actually say that they want to be in the nursing home at any time. But our social safety net is great if you have to be in the nursing home.
But conceptually, as we all want to live a long healthy life and we want to remain as independent as possible as we can, for as long as we possibly can, and none of us will ever want to end up in the nursing home. So our social safety net in Florida is really geared towards people ending up in the nursing home.
But again, none of us want to be in the nursing home. And what we all want to live is, we all want to live in the least restrictive environment possible. So as we age and if we have issues with disability, or if we have issues with dementia care, then there's the great likelihood that we're not going to be able to stay home. And we're not gonna be able to stay home because we need help with activities of daily living or we can't stay home due to our advanced dementia, where even if we can take care of ourselves, we may be a danger to ourselves.
So, when you're not able to stay home, then the reality is that there's many steps before someone having to be in the nursing home. And again, the government will pay for the nursing home care if you qualify, but then most people don't want to be in the nursing home, so you think about how do you pay for assisted living benefits or can the government help pay for caretakers to come out to the home, as well?
Marcia Teele: So, the State of Florida did something about that a number of years ago, right?
Rep DeLoach: That's right. So again, if you go back to the baseline of the nursing home program, what they did is they figured out, "What a minute. People would end up in the nursing home and they ran out of money and they could not afford the assisted living facility." So they said, "Wait a minute, mom or dad, or what have you, ended up in the nursing home, they could go to assisted living, but they just can't afford it." So, there wasn't a government program at all to pay for assisted living. And they realized, "Well, jeez, mom or dad is healthy enough to not be in the nursing home. The nursing home is costing the State of Florida $6,000 a month."
Marcia Teele: Or more.
Rep DeLoach: They could go to an assisted living facility and it'll be a lot cheaper and actually mom would want to be there. It's a much better environment. Assisted living facilities are not nursing homes. They're wonderful places, as you know. And so, the concept is they created these programs that more or less gets mom or dad out of the nursing, gets them into an assisted living facility, and Medicaid can help pay for that.
So again, it's not the baseline. The baseline is the nursing home, but there are programs that were created about 20 years ago or so, that help out with assisted living benefits and also helps with in home care, as well.
Marcia Teele: Right. And so, they're not the same and I know that people think, "Well, gee, if I go into a nursing home, the nursing home, I give them my social security or my dad's social security and my dad's pension and then the state pays the difference." Versus a newer program, within the last 10 or 20 years, for Medicaid for long-term care in an assisted living. But they're not equal, they're not the same, they don't pay the same amount toward care, do they? Let's talk about that.
Rep DeLoach: Absolutely not. And that's a great point. The way it works when a single person ... It's very easy to talk about a single person, because the rules are very similar. When a single person is in the nursing home and they're assets are less than $2,000, their countable assets are less than $2,000, then they can go onto Medicaid. And when they're on Medicaid, all of their income goes to the nursing home and they're allowed to keep $130 per month, which is there for personal needs, allowances, this is money they can keep to pay for any clothing or any other personal needs that they may have.
So, the default is a single person's in the nursing home, all of their income goes to the nursing home when they are on Medicaid. And as you mentioned ... And this is one of the key differences. And again, we said that the default is the nursing home, but they created these other programs that help pay for assisted living care, but it's not that great.
And the Medicaid programs, if you get onto Medicaid in the assisted living facility ... And we'll talk about that process in a bit. If you're able to get on Medicaid in the assisted living facility, what it ends up really providing is a subsidy of about $1,100 to $1,200 per month.
So, it's not like ... So, in the nursing home, the State of Florida pays for everything and all you have to do is pay your income to the facility. That's not the same thing for assisted living Medicaid. All it does is provide say, $1,100 to $1,200 a month as more or less a subsidy to the assisted living facility. And you and I both know that that doesn't always go a long way in paying for someone to be at an assisted living facility.
Marcia Teele: Right. Because even though the state is helping a little bit, the family still has to come up with the difference between that and what the community charges are per month, right?
Rep DeLoach: That's right. The Medicaid program for assisted living and the long-term care Medicaid, it's specifically designed to pay only for medical services. And the medical services, the $1,100 a month, if you will. But it by law cannot charge for room and board. Medicaid cannot pay for room and board.
So, in a typical example I think about is, what if mom's income is $1,500 a month and if she runs out of money and she's trying to stay in an assisted living facility, and mom's $1,500 she has and she can pay that towards the assisted living facility, but Medicaid in the State of Florida will only pay about $1,100 to help pay for her medical costs in the assisted facility.
So, in that scenario, mom's income is only about $2,600 a month. And $2,600 is not a great amount of money to pay for assisted living care. Most assisted living facilities-
Marcia Teele: Yeah, it doesn't leave a lot of options.
Rep DeLoach: Yeah, especially, as you know, when someone has dementia, dementia care is even more expensive for the assisted living facility. So, it is a difficult thing. We all want to, again, lead a long, independent life and we never want to end up in the nursing home, but the Medicaid program itself is not great for paying for the assisted living facility.
Marcia Teele: Yeah, and I think that's a big misconception of a lot of people that I talk to that are new to this idea of taking care of someone long-term. They never really thought about it, they never had to think about it. And now that they're in charge, they might be the power of attorney for a parent or another relative, and they're really blindsided by this, like, "Well, what am I supposed to do? I can get them on Medicaid, but I still can't afford with their income to be in a nice assisted living," especially for memory care, that's a higher level of care. Therefore, costs more than regular assisted living.
They really don't have a lot of resources unless the families can come together and maybe everybody contribute a little bit to it.
Rep DeLoach: That's right. And most people have never done this before. So, I had a call from another attorney, who refers his Medicaid and elder law business to me, a few weeks ago. And the attorney said, "Well, I've got a client and the client wants to stay at home for as long as he can, but then he's gonna spend all of his money. And then once he spends all of his money, he's gonna go onto Medicaid."
And I had to explain to him that, well, what if he spends all of his money and he's trying to stay in an assisted living facility. But if he runs out of money, there's no guarantee that he's gonna be able to stay in an assisted living facility.
So, you and I both know this, is that when children, for instance, are shopping for their mom or dad and trying to get them into an assisted living facility, sometimes they'll ask the person that's their contact at the assisted living facility, we know this happens, and they'll say, "Well, what happens if mom or dad runs out of money while they're staying in this assisted living facility?" And the person, their salesperson, the facility may say, "Well, don't worry. Mom or dad could go onto Medicaid at that time."
But you and I, Marcia, we both know that Medicaid is very difficult to access for assisted living care, and even if you can get it, it only provides that $1,100 to $1,200 a month subsidy. So, an expensive assisted living facility, there's no way that they're actually gonna be able to stay, unless the family chips in.
So, there's so many misconceptions out there about Medicaid and Medicaid planning and of course, assisted living benefits. And our social safety net is just not good for this type of thing without the right planning in advance.
Marcia Teele: That's right. And you know what? That happened actually yesterday. I talked to a daughter, who picked an assisted living for memory care for her mom, based on the fact that, just what you said, the salesperson said to her, "Oh, yes, and if you move here, your mom can stay here until she passes away, even if she runs out of money, because we have Medicaid."
And so, when I spoke to the daughter, I was following up and checking in with her because I had talked to her before and she told me this. I said, "Well, that's not necessarily the whole story. They didn't tell you everything." And some assisted livings do participate in these Medicaid programs through the state and some don't, so it's good to find the ones that do if that's what you're planning for. But just because they say you can stay there if you run out of money, they're not telling the caregivers the real truth and the whole thing. I think it's just so unfortunate that they're misleading people that way. And it just happened yesterday to a daughter I was talking to. And matter of fact, I told her to call you, because she's gonna be in this situation that she may need some extra help and some planning.
So, caregivers have to be very aware of these things when they are shopping and looking for long-term care, because they need to have all the facts. They needs to ask the right questions, but like you said earlier at the top of the program, you don't know what you don't know. And so, that's why we have experts like you here to explain all of these little pitfalls that people should be aware of.
Rep DeLoach: Absolutely, I agree. You and I, we both see it all the time, and a family thought that they were doing the right thing, spending mom's money for the assisted living care, but they're trying to figure out what to do now that mom has run out of money. And the facilities say, "Well, we're not gonna keep her anymore, because she's run out of money." And they're trying to adapt, and the salesperson or the person they were contacting at the assisted living facility, may think that they're doing the right thing, but they don't even know themselves. Medicaid is so very difficult.
Marcia Teele: Well, that's right. They may not understand what's all involved, because they're maybe not educated in the process themselves. So, it's very confusing to say the least, and we want to talk now about if somebody is listening and they think, "Gee, I might be in that boat. I might need to plan," when should somebody start planning for this Medicaid assistance process?
Rep DeLoach: That's really a great question. So, every situation, there's just so many different possibilities, but the first thing that anyone would do is, they would make sure that they have their estate plan in order.
One of the keys to Medicaid planning, whether you're trying to protect assets or not, and of course there are legal ways to protect assets, but whether you're trying to protect assets or not, you need to make sure your estate plan is in order. And your estate planning is creating your will or creating your trust or what have you, but then it's also doing your incapacity planning. And your incapacity planning is gonna be your durable power of attorney, or it's gonna be your designation and your advanced directives, which are gonna be your designation of healthcare surrogate and your living will.
And the first step that you do in order to plan for the future is planning for your death, and then planning for your incapacity with your durable power of attorney and advanced directives.
Marcia Teele: So, that's the first step really. Before they even get into the next process of planning financially, they need to get all of those documents in order so that they have the legal ability to make application or make decisions for the person who can't make them for themselves.
Rep DeLoach: Yeah, absolutely. Because you have to say, well, if mom or dad or the person that's planning is thinking about how do you protect assets or what do you do, you have to make sure you're planning for their death first, and planning for their incapacity. And really, it's the good durable power of attorney is gonna be one of the keys to the castle. Because if don't do those things, you don't really have anything.
And so, what you always do is, you go to a good elder law attorney to create a good durable power of attorney. That's one the most important things that you could do. You don't pull a power of attorney down from the internet, or you don't get it from your uncle who lives in another state. I had that recently. The uncle downloaded a form for mom and it was a terrible power of attorney form. You go to a good elder law attorney to create a good durable power of attorney and get your estate plan done.
Marcia Teele: Absolutely. I've seen-
Rep DeLoach: So, you've got to have your estate plan done in order to do this.
Marcia Teele: You're right, because I've seen people who have downloaded them from websites, I've seen people who get these legal programs that have all these different documents, and it's just kind of a fill in the blank. And that's really not a good idea, because first of all, it may not be specific to Florida. And also, it's not gonna include everything that you might need and then you're gonna be in the boat without a paddle, because you don't have all the tools that you need in order to do what you need to do. So, I've seen it all and I totally agree with you.
Rep DeLoach: Yeah. So after you do that, after you get your estate planning and your incapacity planning done, there are a number of things that you would think about from a Medicaid and asset protection standpoint, and I think that's what you were talking about earlier. What else should you do?
And there's just so many different options you may or may not want to try and take advantage of, depending on your own financial situation. If you're in your 60's and 70's and you're relatively healthy, then you would think about purchasing some type of long-term care insurance or purchasing some type of pension protection act annuity or life insurance policy that has long-term care insurance inside of it.
So, if you're thinking about pre-planning in your 60's and 70's and you're relatively healthy, then you would look at financial pre-planning, which is if you have the money, then you would look at purchasing long-term care insurance. And that's one of the most important things that you could do if you're healthy in your 60's and 70's and so forth.
Marcia Teele: Yeah. If people can afford the premiums, that's a good thing to do. I unfortunately, years ago, had a wife whose husband had dementia. She did get long-term care, and for years and years and years, she paid the premiums. And then when it came time to have her husband go into a memory care assisted living, she was really shocked to find out that what the policy paid wasn't very much. She didn't have an inflation writer and all the other benefits did not add up to enough, because she couldn't pay the difference. It wasn't something that was gonna pay enough all these years later.
So, here's a lady who didn't have a lot of money, thought she was doing a great thing by buying the long-term care, but in the end, it was all for nothing. Almost wasted premiums, because she couldn't use the policy because she couldn't afford to pay the difference. And I was so sad for her. She was kind of between a rock and a hard place at that point.
Rep DeLoach: Yeah. We certainly know that not all long-term care insurance policies are worth it. And you have these older policies, there were less regulations as well, so you can have policies where they can pay for $50 a day, which doesn't go very far, as you can imagine.
But the things that you can do with annuities and life insurance policies that have long-term care insurance writers inside of them, that can actually comprise for very generous benefits in most situations.
So, most people are not buying traditional long-term care insurance policies like the one that you saw anymore. They're generally switching to asset based long-term care. So, that's just something that's sort of one to consider if you're in your 60's and 70's. You have your estate plan done, you're looking to make sure that your long term care is paid for, maybe leave a legacy to your children, you can have these long-term care insurance policies that are generally contained inside life insurance and annuities.
But those again, that's providing for the people that are in their 60's and 70's and fairly healthy. But then you're looking at other options when someone's in their 80's and 90's and beyond. There's a couple different plans-
Marcia Teele: Well, yeah, and it's good to be proactive and get it when you're healthy, because the premiums are gonna be less money and not wait too long. Because a lot of people also don't know that with the underwriting rules of long-term care insurance, once you've been diagnosed with a major health issue or dementia, they're not gonna give you a long-term care policy.
Rep DeLoach: Absolutely. So, traditional long-term care, at age 60, traditional long-term care insurance does not even ... One in five people do not qualify for long-term care insurance at age 60. Where the pension protection act annuities and life insurance policies, those have ... The policies are much easier to ... They have less underwriting standards than traditional long-term care insurance.
Rep DeLoach: But you're right, you have to get it when you are healthy enough to do it. And there's people who already have cancer, if you already have a dementia diagnosis or Parkinson's or a number of different things, you can't do it at that point, because the insurance companies aren't going to underwrite you.
Marcia Teele: Right, it's too late.
Rep DeLoach: Too late.
Marcia Teele: Yeah, you're right. And we kind of preach to caregivers all the time, "Don't wait, don't wait, don't wait." So, don't wait to get long-term care insurance, don't wait to make a decision about moving to assisted living, because if you wait too long, you may end up in the nursing home, because your person may have declined and is not actually appropriate anymore. So don't wait. It's better to be proactive and go sooner than later so that you don't have to be forced into a nursing home situation that you don't want to be.
And also, when you mentioned legal documents, getting your power of attorney and your healthcare surrogate and all of that, we tell caregivers don't wait, because if you wait too long, your loved one may not be able to actually give you their approval or their voice, basically in a power of attorney. And if they can't do that and they don't understand what they're giving you because of the dementia, then you're forced to go the guardianship route, which is gonna be long and expensive.
So, I guess the whole message here is be proactive. Don't wait in any of these situations, because time is of the essence when you're dealing with the legal and the financial arenas with someone that you're caring for.
Rep DeLoach: Absolutely. And just go sit down with a good attorney and listen to them. I mean, I think that's one of the keys. Not all attorneys are created equal. You can go onto NAELA, the National Academy of Elder Law Attorneys, .org, N-A-E-L-A, .org. And any good elder law attorney is going to be listed on there. Much less, you can look to family and friends, but go to a good elder law attorney that does this all the time, because not all attorneys are created equal, as you know.
Marcia Teele: Absolutely true. Let's talk a little bit about VA benefits, veteran's benefits, because we're talking about how people can maybe have some help paying for care, for long-term care, either in a memory care assisted living or regular assisted living, or even in a nursing home. Can the Veteran's Administration help with that?
Rep DeLoach: Definitely. We think about if there's a veteran or the surviving spouse of a wartime veteran, and of course they have to be a veteran, they have to have served in a time of war, they have to serve in active duty, there's certain qualifications, but if they served in a time of war and had a discharge anything other than dishonorable, then they could be entitled to veteran's benefits to help pay for their long-term care.
And the VA specifically set up a program, that if this person ... Even if the veteran or if the surviving spouse of the veteran never received any type of other benefits whatsoever, but there still is a program to help needy veterans. It's not necessarily specifically for long-term care, but it's there to help pay for recurring medical expenses. And mostly long-term care, of course, is a recurring medical expense that the VA could help pay for.
Marcia Teele: So, there's a program through the Veteran's Administration called Aid and Attendance, where people, if they qualify, can get this money. It doesn't go directly to the facility necessarily, but it goes to the responsible party who uses that money to help pay for care wherever the person may be residing, correct?
Rep DeLoach: That's right. So, the VA of course has a lot of different programs. The program that we're specifically looking at is a program that the VA refers to as Pension. And the Pension Program is there to help out the needy veterans in need, and of course surviving spouses of wartime veterans, and the Pension Program has three different levels. It has the base pension level, it has the home bound level for veterans that are not able to leave their home, and it has the highest level of pension benefits that's referred to as Aid and Attendance, as you said.
And out in the general public, everyone refers to it as Aid and Attendance, so that's somewhat correct, but it's really pension with the Aid and Attendance the highest level. And it's a terrible name, if you will, because the derivation is you need the aid and attendance of another human being in order to deal with the wants of nature. And the wants of nature are going to be more or less your activities of daily living. Do you need help with eating, dressing, bathing, grooming, toileting, transferring?
And when you need help with this, in particular the Pension Program can help needy veterans pay for their long-term care. And the Pension Program, for the Aid and Attendance level, the highest level, for a single veteran, it can pay them over $1,800 a month to help pay for their long-term care costs, for instance. For married veterans, over $2,200 per month. And then for the surviving spouse of a wartime veteran, they're able to get a little over $1,200 per month.
Rep DeLoach: So, these programs are really great in the right situations for someone that needs help with paying for their long-term care.
Marcia Teele: So, I get a question a lot from caregivers who ask, "Can my dad get both Aid and Attendance and also get the Florida long-term care Medicaid at the same time? Or is that considered double dipping?" What do you say about that?
Rep DeLoach: It is possible to get concurrent benefits in a particular situation you think that the concurrent benefits would be helpful. See, there's so many different scenarios you can consider. But most likely that you could get Medicaid benefits and VA benefits, it's most likely to be for someone who's gonna stay in an assisted living facility. It's possible for them to get Medicaid benefits to help pay for assisted living, but it's still possible that that person also gets VA benefits, which can also pay for the assisted living facility.
Now, the VA benefits program is based upon you spending money on your out of pocket medical costs. These out of pocket medical costs can be the costs for assisted living. And when you're spending money out of your own pocket, then the VA benefits can do that and you can get Medicaid as well. So, it's certainly not impossible. And you would more likely than not see than when mom or dad or someone that's applying is in the assisted living facility. That's a more likely time that you would see something like that.
Marcia Teele: Right. And there's a lot to learn about applying for VA benefits and applying for the Medicaid, and that's why I'm always telling people to go see a board certified elder law attorney like yourself. So, a lot of caregivers say to me, "Well, I called the VA. I want to do my own thing and I called the VA and I talked to somebody, and they told me blah, blah, blah, X, Y, Z. And then I find out that's not true. Or I talked to somebody else at the VA and I hear something different." Have you come across situations like that, where caregivers are getting misinformation or different or wrong information from VA representatives?
Rep DeLoach: Absolutely. The first thing you think about is-
Marcia Teele: Why is that?
Rep DeLoach: Well, because the VA doesn't know themselves.
Marcia Teele: They don't know themselves?
Rep DeLoach: You've heard the statistic where someone calls up the IRS and they get the wrong answer about 50% of the time from the IRS person on the phone. And there are so many different potential areas that the VA benefits are out there, and it's just difficult.
So, the first thing you say is, "Well, an elder law attorney will not charge." They're basically forbidden from charging to help someone do a VA application. So, they could always go see an elder law attorney and the elder law attorney may always triage the situation and send you down to the VA accordingly. But the thing is that we have seen the VA give wrong answers.
And I always think about this one. It was a very accurate situation. And mom was living at home, she had advanced dementia, she shouldn't have been living at home. And her income was $1,200 per month and she had no assets whatsoever. And so, the son knew that her husband was a wartime veteran. He went down to the VA and asked, said, "Hey, can I get my mom money?"
And you and I both know that in the right situation, the VA would help pay her $1,200 a month to help pay for her long-term care. But the VA said, "No, she's not eligible for VA benefits." And-
Marcia Teele: Why? Why would they say that?
Rep DeLoach: Well, their answer was technically correct. She was not eligible benefits. Living at home-
Marcia Teele: But for spousal.
Rep DeLoach: What?
Marcia Teele: But spousal benefits?
Rep DeLoach: She wasn't eligible. From the definition, she wasn't eligible. They didn't happen to say, "But if you moved your mom to an assisted living facility tomorrow, she's entitled to $1,200 a month." They didn't happen to say, "But if you paid a caregiver to come see her and that was an out of pocket expense, then the VA could help you out as well."
So, living at home without any out of pocket medical expenses, she technically wasn't eligible for VA benefits. They just didn't happen to say, "But if you moved her to an assisted living facility tomorrow, then that's an offsetting medical expense and now she's eligible for VA benefits."
So, we know these things happen all the time and they just get terrible information. But the system itself, the VA is a very large bureaucracy, you don't know the quality of the information that you'll get. And that's where you would ... I say go see an elder law attorney, but the elder law attorney can help triage the situation and say, "Yes ..." Will they get VA benefits or will they not get VA benefits. But the elder law attorney shouldn't do the VA benefits application for them, because they generally can't charge to do that.
Marcia Teele: Right. And so, getting the information from the VA, they're just kind of answering the question, black and white.
Rep DeLoach: That's right.
Marcia Teele: They're not looking at the big picture, they're not looking at the scenario of the care that might be needed. They're just answering the question. So like you said, technically they're right, but that's not what the son really needed to know.
Rep DeLoach: That's right. So, they're not there ... They say that you don't even need an elder law attorney or you don't need an attorney to apply for VA benefits, because the VA is there to help answer everything and be their advocate, but we know that's just not the case. And mileage varies.
Marcia Teele: Yes. I have had caregivers tell me that they've been approved for VA benefits or Medicaid benefits pretty quickly, and others say that it's been months and months and months and they never hear anything. So, what would make the difference between somebody getting approved for help quickly or quicker than other people? Is there a trick to it?
Rep DeLoach: That's funny. I guess I have a joking answer. The joking answer is if there is a trick to it, I wish I knew the trick. The VA is a large and difficult bureaucracy, and it is difficult to get applications to go through quickly. If there is a trick, the real thing is this. A while ago, they enacted more or less a fast track procedure. And if you apply for the VA with everything you could possibly give them and there's nothing else to give them, then it's likely that that is a way to get a quick answer from VA benefits.
What happens though is, the VA says, "Oh, you didn't fill out this form the right way. You didn't answer this the right way," or any number of delays. As soon as they have a question that they have to give out to you and go back to you, if there's another question, then you're entered the slow way. And the slow way can take six months and more. That's just the reality of the situation.
But if there is the right way to do a VA application, it gives every single bit of information you can the first time, and if they never have to come back and ask another question, then you're likely to get that application for Pension or for Aid and Attendance benefits in quickly.
Marcia Teele: Right. Well, I've even heard that if you leave something blank because it doesn't apply, then don't like that because they think maybe there was something that you should have put there. Maybe you missed it, maybe you forgot. So, even a blank box might cause it to be rejected and go to the bottom of the pile.
Rep DeLoach: That's right. For instance, you have to list all your income and all your assets. And if you just happen to leave the blank for stocks, bonds, what have you, if you just left it blank, then they could make the assumption that there is something there. So yes, you have to make zero. That's the way they do it.
Marcia Teele: Yeah, and these are little things, but to dot the I and cross the t when you're doing it yourself, it's really hard. And if you miss one thing, then you're ... Again, you have to wait a lot longer. So again, another reason to have some professionals help you.
Well, unfortunately everybody, we're out of time. This has been great. Thank you, Rep DeLoach, elder board certified attorney for being with us today.
If you want to call, get more information, 727-397-5571 or check them out on their website, dhclaw.com. They've got a great website, lots of good information. Call them up, ask them for a consultation.