When someone comes into our offices after caring for a loved one with declining health, often they have been a caretaker for a long time. It is not uncommon for these clients to have drained many of their own resources, whether those be personal or financial. They may have been caring for their spouse in their home and realized it was no longer a safe environment, or the daily medical assistance needed to provide a safe home may be too overwhelming to administer. Either way, when the well-spouse begins considering moving their suffering partner into a nursing home, they often start with the resources around them, whether it be close family members or others in the community.

Over the last few months, we have had the pleasure of working with a family who came to us after consulting with one of their closest friends. These two men have lived in the same neighborhood together for several years and had taken counsel with one another through good, bad and challenging times. Both were caring for their wives, while contemplating transitioning them into a nursing home. While being so occupied by caring for their wives, they hadn’t been able to keep in touch like they had just a few years before. So, when one friend told the other he had recently transitioned his wife to a nursing home, the other confided in him that he too, was contemplating making the same difficult decision.

I’m sure many personal stories were shared between these two longtime friends. I’m confident these discussions helped them cope and endure their mutual circumstances. That’s what friends and neighbors are for. One of the stories shared with us about their conversations, was the referral of a book called the Complete Guide to Caring for Aging Loved Ones. Authored by Robert Riekse of Focus on the Family, this book provides advice for caregiving loved ones and for those transitioning another into a nursing home. Here is a summary from Amazon, “Whether you're preparing for the responsibility or are in the midst of caring for an elderly loved one, this complete guide from Focus on the Family provides the practical information you need―and a spiritual and emotional lifeline. Topics include burnout; physical, emotional, and mental changes in aging; medical, financial, and legal help; elder abuse; choosing a care facility; and end-of-life decisions. Caregivers will also learn what the Bible says about caregiving and the keys to effectively fulfilling that role. True stories throughout the guide share common concerns and a sense of support from those who have been there.”

I understand the challenges of taking care of our loved ones with declining health cannot simply be answered with a book. However, it is important that we are willing to accept help from others and look out for resources in our communities that are there to assist us with our caregiving. I do not receive any financial benefit from recommending this book, and it is just one of dozens of great editorial resources available. However, I can say that it has assisted a least two clients in the last year while they managed caring for their loved ones in the home, and while transitioning them into nursing homes.  This story most importantly highlights the importance of reaching out to others in our lives for advice and help.
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Berger Estate & Elder Law, P.A. has been serving Kansas City for over 30 years -- providing Trusted Council with Proactive Solutions. Call us today at (913) 491-6332, visit our website berger-lawfirm.com , or stop by our conveniently located offices at 11233 Nall, Suite 140, Leawood, KS 66211 for more information.

Over the years we’ve had our fair share of difficult situations to handle. These often have a wide array of challenges, that one can only imagine working in elder law for over 30 years. The most difficult challenge of all is seeing families struggle through difficult times. Our responsibility in these situations is to help guide others through their circumstances and provide them with the best options to remedy their situation.

But as the saying goes, “what has been done can’t be undone,” and this is often the feeling someone has when a another accuses them of neglect and abuse.  Thankfully, we have been able to help clients that have been falsely accused in these situations, but often these issues can be better managed if handled differently early on.

For first time caregivers, and especially those caring for someone they love, it is often easy to take on too much. This can lead to feelings of resentment and regret, and questions of “what if?” can start to settle in. This may damage loving relationships and leave one susceptible to malicious accusations by financial institutions, social workers, caregivers, extended/out-of-town family members and outsiders that aren’t as involved in the care taking responsibilities as the person taking on the majority of these tasks.    

The timeline of the story often goes in stages, but the stages are reoccurring for many spousal and adult-child caretakers. The worst-case scenario is one we see all too often and that is one that includes a caretaker being accused of neglect or abuse. Often, when someone is diagnosed with some form of dementia, a loved one, like a well-spouse or adult-child will step in and try to be the best caretaker they can be. Reasonably, this is thought to be the best option, as they are the closest and most knowledgeable person in the room about the day-to-day ailments of the sufferer. Additionally, they have more invested emotionally and physically than anyone. They are willing to go above and beyond in their care, literally doing whatever it takes to help their suffering spouse or parent.

The pitfalls of caregiving are well documented, but possibly the biggest is when you try to take too much on our own. The exact time, when too much is too much, is hard to recognize and that is why it is helpful to be in constant communication with others. Many delay asking for help for numerous reasons, but the one we see most is guilt. The guilt of asking for help, the guilt of blaming yourself for the situation and the guilt of not being able to handle it all on your own. But, this shouldn’t be the case and this reasoning is usually unjustified and simply not true. Dementia is no one’s fault and calling out other stretcher-bearers to help carry the burden, as soon as possible is often the right thing to do.

Two suggestions we continually make to clients under these circumstances are: (1) bring on more than one stretcher bearer. These could be friends, neighbors, care-givers, your church community, or social workers etc., or (2) consider a nursing facility and don’t feel guilty about it. These recommendations may sound simple, but they are often ignored and unheeded.

Ask for help before it’s too late. Too many times we’ve been contacted by a well-spouse or adult child after a third-party institution or organization has reported them for neglect or abuse. These cases are often concocted stories from third-party sources, that care more about protecting themselves than the individuals involved. Others, often blame the well-spouse or adult child for anything and everything that happens to the individual suffering from dementia, because they may be insecure of their own involvement with the situation. Having multiple stretcher bearers, with different experiences and perspectives offers families more lines of communication and observation. This not only relieves some of the pressure from caretaking, but provides a diverse system of checks and balances. In a way, it is doing your due diligence.

Unfortunately, the legal system has seen its fair share of exaggerated elder abuse and neglect claims, however with the right counsel, protecting yourself from these claims is possible. Not to belittle these cases or portray them all as being unwarranted, as many aren’t, but unfortunately, we live in a society where everyone wants to try to blame somebody else, even when there is no one to blame.  As the saying goes, "no good deed goes unpunished." 
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Berger Estate & Elder Law P.A. has been finding solutions throughout Kansas City for over 30 years providing Trusted Counsel with Proactive Solutions for many. We’ve been helping individuals plan, navigate and conquer the challenges of caretaking for over 30 years. Give us a call today at (913) 491-6332, visit our website berger-lawfirm.com or stop by our conveniently located offices at 11233 Nall, Suite 140 Leawood, KS 66211 for more information.

Discussing your estate planning over the holidays may not feel like the best timing, but there may not be a perfect time. These discussions are vital for carrying out your wishes and making life easier for everyone around you. That’s why it may be easier to start asking yourself and dropping hints to others about some of the most important issues during the holiday's, so you can work your way into taking them on directly.

​The death of a friend or an event in the news can often be a natural segue into a discussion about your wishes. To get the gravy ‘flowin' this fall, we put together a list that might be helpful, with the Ten Most Important Elder and Estate Planning Decisions to Discuss with Your Family Over the Holidays.
 
1.       Who do you want to talk to your doctors if you are too sick to do it yourself? Do you have a second
          choice for a backup?
 
2.       Who do you trust to handle your finances if you are not able? Would you like them to be able to act
          immediately, or only if you are not able?
 
3.       If you are terminally ill, are there any limits to the medical treatment you would find acceptable?
 
4.       Do you really know what is meant by a “DNR” – “Do Not Resuscitate Order”?
 
5.       Are your important papers and financial information kept in one place? Who besides you knows where
          this is? What about a safe deposit box? Will anyone have access to it if you are disabled or upon death? 
          Do you have a computer? Do you have a list of passwords? Where is it kept?
 
6.       Have you made any plans for long term care? How will you pay for it?
 
7.       Do you want to be buried or cremated? Where?
 
8.       How do you want your estate distributed after your death? Do you have a will or trust? Have you
          reviewed it lately? Are there any special needs that must be taken care of for your family?
 
9.       How are your accounts titled? Are there any joint accounts that could create unexpected consequences?
 
10.    Do you have an attorney, accountant or financial adviser? Who are they? Does anyone else know them?

​Berger Estate & Elder Law P.A. has been serving Kansas City for over 30 years providing Trusted Counsel with Proactive Solutions. Give us a call today at (913) 491-6332, visit our website berger-lawfirm.com or stop by our conveniently located offices at 11233 Nall, Suite 140 Leawood, KS 66211 for more information.

Some stories are just better when they have a happy ending and I guess I’ll spoil it for you. This one does. But then again, is there ever a client story we share that doesn’t? Fair warning, this is almost a story about Jack and Diane, you know, the one about “two American kids doing the best that they can.”

Fred and Charlene Henrick grew up in Kansas City, Missouri following WW2, after Fred returned from the war. Their life following was one that resonates with the times. Fred took a job with Ford Motor Company at the Claycomo Plant when they opened in 1951. Charlene was a math tutor for high schoolers, working out of their house and soon would be raising three children. After 35 years, when the kids were all grown and had moved away, the Henricks decided to move out to the “country”, to Olathe, Kansas.

Well, a lot has changed in Olathe since then and the same would be true for the Henricks. Soon after moving to Olathe, one of their daughters, Aubrey, moved back from Texas, so the grandchildren could be closer to Grandma and Grandpa.

After leaving Ford and moving out to Olathe, Fred continued to work part-time with a local mechanic and Charlene continued to tutor math, although often for younger children like her grandkids. The Henricks' hope was that these finances would be enough to pay for retirement and leave a little legacy for their children, like their home Aubrey was already taking care of all by herself. Having Aubrey down the street wasn’t just good for “free” babysitting and keeping the home safe for her parents, because as time went on, Aubrey was also beginning to spend more time taking care of Fred. 

Eventually, Fred’s physical health started to decline faster, while his dementia also seemed to be getting worse. It came time that Charlene and Aubrey could no longer safely care for Fred and they began looking for home health or Skilled Nursing solutions. When discovering the costs of Skilled Nursing, they quickly realized that their finances would not even allow Fred to reside in a community for much over one year and after that they believed they would have to sell their home, which would be all that was left of 65 years of being together. Even though Fred is 93, they were hopeful he would live much longer than a year, so they reached out to a friend who had assisted in moving both of her parents into a local Nursing Home.

Hearing the wonderful family stories of the Henricks is one of the benefits of practicing Estate Planning and Elder Law. However, many families we talk to don’t consider estate planning soon enough to be prepared for long-term care when they need it.  And, this often changes good stories into bad. Thankfully, with the proper guidance, waiting until later or when the need arises in life doesn’t mean it’s too late.

After reviewing the Henricks case, they looked to be in good position for applying for Medicaid. This process is fairly straightforward, if you know the hoops to jump through and are prepared to handle continued correspondence with KanCare. Anyone who has filed for Medicaid knows that inevitably, the process is tedious and requires a lot of patience.

Although these rules seem to be a bit fluid at times, one can usually know which part of the application will raise concerns with KanCare, so it is best to be prepared before this happens. To KanCare’s credit, their concerns are almost always valid, given the high level of fraud they must deal with and being stewards of government funds.

When KanCare approved Fred for nursing home benefits, he was assessed a patient obligation to the nursing home. This obligation was basically Fred’s social security and pension income, less a monthly needs allowance. Although we were pleased to see that Fred was approved for Medicaid, we questioned why none of his income had been allocated to Charlene. After further communication with KanCare, it was determined that Charlene would receive a portion of Fred’s income to help her pay her own shelter expenses. The ultimate result is that Fred’s monthly out of pocket cost of care was $650.

More Nursing Homes are beginning to accept Medicaid as payment for care. However, many do not accept residents unless they are already approved or have hired an Elder Law attorney for help.

Berger Estate & Elder Law P.A. have been assisting families and seniors with Medicaid Planning and Long-Term Care Planning in Kansas City for over 30 years providing Trusted Counsel with Proactive Solutions. Give us a call today at (913) 491-6332, visit our website berger-lawfirm.com or stop by our conveniently located offices at 11233 Nall, Suite 140 Leawood, KS 66211 for more information.​

The median cost of a private nursing home room in the United States increased to $100,375 a year in 2018, up 3 percent from 2017, according to Genworth's Cost of Care survey, which the insurer conducts annually.

At the same time, Genworth reports that the median cost of a semi-private room in a nursing home is $89,297, up 4 percent from 2017. While significant, the rise in prices is not quite as steep as the 5.5 percent and 4.4 percent gains, in 2017.

But the median cost of assisted living facilities jumped 6.7 percent, to $4,000 a month. The national median rate for the services of a home health aide is $22 an hour, and the cost of adult day care, which provides support services in a protective setting during part of the day, rose from $70 to $72 a day.

Kansas and Missouri continue to be two of the most affordable states for nursing home care by far, with the median annual cost of a private nursing home room totaling $70,379 and $66,521 respectively. Oklahoma again was found to be the most affordable state, with a median annual cost of a private room of $63,510.

The 2018 survey, conducted by CareScout for the fifteenth straight year, was based on responses from more than 15,500 nursing homes, assisted living facilities, adult day health facilities and home care providers.  Survey respondents were contacted by phone during May and June 2018.

As the survey indicates, nursing home care is growing ever more expensive. Contact your elder law attorney to learn how you can protect some or all of your family's assets.

For more on Genworth’s 2018 Cost of Care Survey, including costs for your state, click here.
 
Berger Estate & Elder Law P.A. have been assisting families and seniors with Medicaid Planning and Long-Term Care Planning in Kansas City for over 30 years providing Trusted Counsel with Proactive Solutions. Give us a call today at (913) 491-6332, visit our website berger-lawfirm.com or stop by our conveniently located offices at 11233 Nall, Suite 140 Leawood, KS 66211 for more information.​

The federal government is issuing new Medicare cards to all Medicare beneficiaries. To prevent fraud and fight identity theft, new cards will no longer have the beneficiaries' Social Security numbers on them.

Centers for Medicare and Medicaid Services (CMS) is replacing each beneficiary's Social Security number with a unique identification number, called a Medicare Beneficiary Identifier (MBI). Each MBI will consist of a combination of 11 randomly generated numbers and upper-case letters. The characters are "non-intelligent," which means they don't have any hidden or special meaning. The MBI is confidential like the Social Security number and should be kept similarly private.

The CMS will begin mailing the cards in April 2018 in phases based on the state the beneficiary lives in. The new cards should be completely distributed by April 2019. If your mailing address is not up to date, call 800-772-1213, visit www.ssa.gov, or go to a local Social Security office to update it.

The changeover is attracting scammers who are using the introduction of the new cards as a fresh opportunity to separate Medicare beneficiaries from their money. According to Kaiser Health News, the scams to look out for include phone calls with callers:

• Claiming to be from Medicare looking for your direct deposit number and using the new cards as an excuse
• Asking for your Social Security number to verify information
• Claiming Medicare recipients need to pay money to receive a temporary card
• Threatening to cancel your insurance if you don't give out your card number

There is no cost for the new cards. It is important to know that Medicare will never call, email or visit you unless you ask them to, nor will they ask you for money or for your Medicare number. If you receive any calls that seem suspicious, don't give out any personal information and hang up. You should call 1-800-MEDICARE to report the activity or you can contact your local Senior Medicare Patrol (SMP). To contact your SMP, call 877-808-2468 or visit www.smpresource.org.
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 Berger Estate & Elder Law P.A. has been finding solutions throughout Kansas City for over 30 years providing Trusted Counsel with Proactive Solutions for many. Give us a call today at (913) 491-6332, visit our website berger-lawfirm.com or stop by our conveniently located offices at 11233 Nall, Suite 140 Leawood, KS 66211 for more information.

Recently, I had a conversation with a client about his wife being in memory care. “Joe”, who recently went through the Medicaid process with our firm, has meals a few times a week with his wife. They regularly eat at the community where she lives in Olathe, Kansas. During this conversation and while eating the incredible German chocolate cupcakes he brought in, Joe commented that he still enjoys eating out at local restaurants. Being able to qualify for senior discounts for quite some time, Joe and his wife used to make a hobby of searching out weekly specials and discounts. He says that, if you hit the right specials at the right times, you can eat cheaper going out than staying at home. Of course, if you don’t order drinks he says. Now this is a theory I’m interested in trying.

Since living apart from his wife, Joe commented how much he misses going out to eat in the company of his wife. Despite this, he said he still enjoys going out, albeit by himself most days and Joe still makes the weekly rounds hitting some of the best specials in town. Joe says its just not the same without someone else to sit with and talk to, but did comment that having his iPad to read or “act” like he’s reading makes feeling comfortable easier. Funny, I think we’re all guilty of that.

This conversation reminded me of an old hometown favorite restaurant, Tippin’s. For those living in Kansas City for some time, you’d remember that, back then, they not only had a lot of great pies, but a few restaurants too.  I remember eating at their Metcalf location on a regular basis with Sue, she would order the French Silk and my favorite Pecan. We always enjoyed the food and old-time courtesies of dining back then.

One thing Tippin’s restaurants had at every location was counter service. One could always count on at least a few single souls, mostly seniors, reading the paper or chatting with others at the counter, with attached swivel chairs. This was a staple of their ambiance, and card games could also be found being played in the back midday. Should we start a bring back Tippin’s restaurants campaign or what?

Other iconic Kansas City restaurants with counter service that are still around are Winstead’s, Town Topic, and Pegah’s (which has a location in what used to be Sterns, if you’re up to speed on all things Old Shawnee and an old IHOP, both of which had large counter service areas).  For some time now, Town Topic has been quite the hot spot for millennials and hipsters, making it less desirable for some seniors, but quite an interesting development in the possibilities of counter service making a comeback. Franchises like IHOP, Denny’s, Perkins, Shoney’s and Waffle House were all once known for their counter service, but these restaurants are either losing locations or updating with limited counter service or none at all.
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How about you? Do you miss the old counter service style of restaurants? Wish they would bring it back? Or know of any secret gems around KC that Joe or other seniors around town would enjoy? Let us know in the comments below and we’ll be sure to share them with our clients.

Berger Estate & Elder Law P.A. has been finding solutions throughout Kansas City for over 30 years providing Trusted Counsel with Proactive Solutions for many. Give us a call today at (913) 491-6332, visit our website berger-lawfirm.com or stop by our conveniently located offices at 11233 Nall, Suite 140 Leawood, KS 66211 for more information. ​

​Assisted Living Communities are a housing option for people who can still live independently but who need some assistance. Costs can range from $2,000 to more than $6,000 a month, depending on location and are rising (up over 3% in the last year). Medicare won’t pay for this type of care, but Medicaid might. Kansas and Missouri Medicaid programs will cover at least some assisted living costs for eligible residents.

Unlike nursing home stays, there is no requirement that Medicaid pay for assisted living, and no state Medicaid program can pay directly for a Medicaid recipient’s room and board in an assisted living community. But since assisted living costs roughly half the cost of a semi-private nursing home room, state officials understand that they can save money by offering financial assistance to elderly individuals who are trying to stay out of nursing homes, any way they can. 

Currently, in 2017, 43 states and the District of Columbia provide some level of financial assistance to individuals in assisted living, according to the website Paying for Senior Care, which features a “State by State Guide to Medicaid Coverage for Assisted Living Benefits” that gives details on each state’s programs.   

The level and type of support varies widely from state to state.  Prevented from paying directly for room and board, some states have devised other strategies to help Medicaid recipients defray the cost of assisted living, including capping the amount Medicaid-certified communities can charge or offering Medicaid-eligible individuals supplemental assistance for room and board costs paid for out of general state funds. States typically cover other services provided by assisted living facilities. These may include, depending on the state, coverage of nursing care, personal care, case management, medication management, and medical assessments and exams.   

In Kansas, KanCare is the managed care program for almost all Medicaid recipients, including those who qualify for Home and Community Based Services (HCBS) or the Frail Elderly (FE) waiver. These programs are designed not only to assist in paying for services provided to help individuals stay in their own homes or homes of loved ones, but also in their chosen assisted living community, as long as the community accepts Medicaid payments. HCBS/FE does not cover room and food costs, but will pay for “direct services provided to the customer in accordance with the Plan of Care” (kdads.ks.gov).

To qualify for one of these waiver programs, applicants must have care needs equivalent to those of nursing home residents.  These waiver programs often have a limited number of enrollment slots, meaning that waiting lists are possible. 

Eligibility guidelines include:

•          Must be over 65 years of age
•          Assessed by a medical team and determined to require assistance for at least 2-3 activities of daily living (description of these activities).
•          Single applicants are allowed monthly income up to $2,205. However, individuals with income exceeding $729/mo will be responsible for a portion of their expenses. Married couple’s incomes are considered separately if only one is applying for Medicaid.
•          Nonexempt asset limits for a single applicant are $2,000 and $4,000 for a couple, one personal vehicle, household items and home equity no more than $560,000. Exempt assets include retirement accounts of well spouse, irrevocable trusts, cemetery lots, term life insurance, prepaid funeral plan, and life insurance with a face value less than $1,500.

MO HealthNet is the Supplemental Nursing Care (SNC) program that offers financial assistance in Missouri for assisted living and nursing home stays. This program offers less financially than KanCare for assisted living, paying up to $292/mo. The cap is much higher for nursing home care and like KanCare often covers some of the difference between a determined individual contribution and the cost of care for Medicaid accepting communities.

Eligibility Guidelines include:

•          Must be over 65 years of age and certified by the Department of Health and Senior Services (DHSS) for needing their desired level of care.
•          Must live in an assisted living residence, it is not required the community accept Medicaid (all funding is provided by the State of Missouri).
•          Applicants having less than $854/mo (single) or $1,129 (couples) of income receive benefits at no cost. Individuals or couples making over those limits must show medical expenses that make them “medically needy” or are responsible for some care costs.
•          Nonexempt asset limits are $2,000 for a single applicant and $4,000 for couple, one personal vehicle, household items and home equity no more than $560,000. Other exempt assets include retirement accounts of well spouse, irrevocable trusts, cemetery lots, term life insurance, prepaid funeral plan, and life insurance with a limited face value.

Much of this article was sourced from Paying for Senior Care’s website (payingforseniorcare.com). For more details about these or similar programs in other states go to Paying for Senior Care's page for assisted living benefits, which includes a state-by-state guide to Medicaid’s coverage for assisted living.
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If you or anyone you know is being burdened with the high costs of care, worried their available resources will quickly be depleted, and believes they may qualify for Medicaid, please reach out to us and call (913) 491-6332, visit our website berger-lawfirm.com or stop by our conveniently located offices at 11233 Nall, Suite 140 Leawood, KS 66211 for more information.