Medicare and Medicaid sound alike, but the two programs should not be confused. After age sixty-five everyone automatically qualifies for Medicare. It’s a federal health insurance program. There are deductibles, and monthly premiums are deducted from social security payments. It can pay for hospitalization, doctors, prescriptions, and rehabilitation. It does not pay for long term care. Unless you can qualify for Medicaid (Title 19) you will have to pay for long term care yourself. That can quickly wipe out assets and at nursing home costs can approach $18,000 a month. So how do you qualify for Medicaid?

People sometimes ask, “Can I do a Medicaid application by myself?” From an attorney’s point of view, that’s somewhat like asking a doctor if you can do an operation by yourself. But you wouldn’t ever ask the doctor that because of all the unknown steps and complications of the operation. In many respects, the pre-operative preparation, the double checking that takes place, and being ready to deal with all the complications that can arise, are analogous to going through the Medicaid process. Here’s why.

Those three words form a huge percentage of calls for elder law services. The calls are made because adult children have come to realize that their elderly mom cannot safely take care of herself anymore. Whether caused by physical or cognitive issues, that mother who was a pillar of the family’s house through life needs help. What kind of help, where to get it, who is going to give it, and how can the family afford it are the critical questions. The “what kind of help” relates to help with the activities of daily living, such as bathing, dressing, feeding, toileting and personal safety.

While you won’t be planning a trip to the land of Oz like Dorothy, someday you will be thinking about how to pass on your life’s savings to your children and grandchildren. The automatic though is “I need a Will.” That is always true but trusts and beneficiary designations can also play a vital role. A will is a legal document that passes assets to the people you name, if those assets don’t pass to them because of joint ownership or beneficiary designations, or by trust. So, a will is always needed just in case the house, or bank account or stocks and bonds do not automatically transfer to the persons you want.

Years ago, Congress, passed laws to protect a husband and wife family unit from being totally wiped out financially if one of them needed expensive long term care, at home or in a nursing home. Then Medicare and Medicaid regulations were adopted to implement those laws. Ironically, they are called spousal impoverishment regulations, but the purpose is the exact opposite, which is to avoid total impoverishment.

Care is the key word in Life Care Plan. Care is what is needed when a person’s physical condition or mental functioning is reduced to the point where the help of another person is needed. That would be due to disease, dementia, accidents or any condition or event that reduces a person’s ability to function normally and do the activities of daily living such as bathing, dressing, eating, getting in or out of bed or toileting. The spouse or other family members provide most of this help in the early stages of physical or mental decline, but at some point it may not be realistic for the family to give that care. Children may  live far away, or the spouse may not be able to cope due to advanced age. Sometimes a healthy spouse gives so much physical and emotional effort that burnout occurs, which means that healthy spouse’s emotional strength is burned up and that spouse’s health also declines. That is where a life care plan is invaluable..