What Every Couple Should Know When One Spouse May Have To Enter A Nursing Facility
The decision for one spouse to enter a nursing facility is often one of the most difficult a couple can make. Before considering a nursing home, it is worthwhile to explore the possibility of home and community based services and/or special housing programs. Often a combination of appropriate services can delay or even prevent nursing home placement.

Is Nursing Home Care needed?
Each community offers diverse service programs. Ask Seniors First for more information on alternative services, including Home Health Care Aides, Homemaker/Aides, In-Home Support Services, Home Delivered Meals, Congregate (group setting) meals, Assistive Devices, Adult Day Care Facilities, Transportation, Rehabilitation Facilities, Telephone Reassurance, Home Repair and Modification Programs, Hospice and Respite Care.

The cost of staying in a nursing facility can easily exceed $50,000 a year. Many people spend their life savings during the first year in a nursing facility to pay for the care.

For pre-placement counseling, contact Seniors First at 530-889-9500 or 1-800-878-9222 for free information about home and community services that help individuals with disabilities lead healthy, independent lives, and remain in their own homes.

Finding Out About Nursing Homes
Types of Residential and Nursing Homes: Some nursing facilities are specialized by the level of care, a specific type of disability or an age group - others have mixed populations. Different types of facilities include skilled nursing, intermediate care, residential care, multi-level residential, mental health, and board and care homes.

Certification, Accreditation and Review

When considering long term care facilities, it is important to ensure that they have the appropriate licensure

For specific information on facility licensing, rules, regulations, and credentialing, you may contact the following State of California offices:

The Long-Term Care Ombudsman, Department of Aging
Ombudsman Services of Northern California
3950 Industrial Blvd., Suite 500
West Sacramento, CA 95690
916-376-8910 for Sacramento County
530-823-8422 for Placer County

Department of Health Services
714 P Street, Room 1253
Sacramento, CA 95814
1-800-554-0354

Health & Welfare Agency, Department of Social Services
744 P Street
Sacramento, CA 95814
916-327-2445

For Problems With Care Facilities:

Long-Term Care Ombudsman services are available in each county. Each licensed facility is required to post the phone number of their local Ombudsman's office in clear sight. In the event of an emergency only, call the Ombudsman Statewide Crisis Line (800) 231-4024.

Financing Nursing Home Care/Medi-Cal:
The nursing facility's administration may help you determine if you are
eligible for Medi-Cal to pay the costs of your nursing home. If not, they
can explain under what conditions you may become eligible in the future. The law requires that nursing home residents receive identical treatment regarding transfer, discharge, and provision of services regardless of the source of payment. A Medi-Cal resident can stay in any bed in a nursing facility.

Spousal Impoverishment Provision:
Couples looking at nursing home placement for a spouse need to be aware of the special laws enacted that allow the spouse remaining at home to keep a certain amount of income and resources when the other spouse enters a nursing home. This is intended to prevent impoverishment of the spouse at home.

Income:
For 2004, the spouse at home may keep all of the couple's income up to $2,319 per month. This is called the community spouse's "monthly maintenance needs allowance". Note: This amount is adjusted annually by a cost of living increase. The spouse at home may obtain additional income or resources through a "fair hearing", or by court order. If the spouse at home receives income above the $2,319 limit in his/her name only, he/she can keep it all (this is called the "name on the instrument rule"); however, he/she will not be allowed to keep any of the nursing facility spouse's income. Income received by the nursing facility spouse will go to his/her share of cost. The spouse in the nursing home is allowed to keep $35 monthly for personal needs ("personal needs allowance").

Resources:
As of January 1, 2004, the spouse at home can keep up to $92,760 in
resources, and the institutionalized spouse may keep up to $2,000. This
resource limit changes each year based on the Consumer Price Index.
(Different laws apply to spouses who entered a nursing facility before
September 30, 1989. If this is the case, the individual should contact a
lawyer/advocate knowledgeable about this area of the law.) Both separate property (i.e., from a previous marriage or inheritance) and community property that is not exempt are combined and counted at the time of application for Medi-Cal. Once the resource limit has been reached, all ownership interest should be transferred to the spouse at home. The institutionalized spouse's $2,000 resource limit should be kept separately and accounted for separately.

Transfer of Assets:
Institutionalized Medi-Cal recipients or applicants who transfer non-exempt assets for less than fair market value during a 36 month "look back" period may be subject to a period of ineligibility. The length of the ineligibility period depends on the value of the transferred asset or resource and date of transfer period. The period of ineligibility begins on the date the transfer was made. The 36 month "look back" period begins when an institutionalized person applies for Medi-Cal or when a Medi-Cal recipient is admitted to a nursing facility. A 60 month "look back" period for assets from certain trusts is also required.

Trusts:
Federal law amended trust regulations and makes it more difficult to set up a Medi-Cal qualifying trust for eligibility and estate claims purposes. For a trust already established, it is recommended that an attorney review it.

Estate Claims and Liens:
Liens are imposed on living Medi-Cal beneficiaries' estates to hold property until the beneficiary or surviving spouse dies. Estate claims are claims made against the estate of the deceased Medi-Cal beneficiary.

Federal law expands California's ability to seek recovery from a deceased Medi-Cal beneficiary's estate for expenses paid under the Medi-Cal program. This will affect individuals aged 55 years or older who received services provided by Medi-Cal or anyone who received Medi-Cal benefits in a nursing facility.

Federal law also allows the State of California to define "estate" to include any real and personal property that the Medi-Cal beneficiary had any legal title to or interest in at the time of death. The definition may include assets held in joint tenancy, tenancy in common, survivorship, life estate, living trusts, etc. If an asset is held in joint tenancy at the time of the Medi-Cal beneficiary's death, the State can seek recovery from the deceased beneficiary's portion of the asset to recover benefits paid under the Medi-Cal program. No recovery can be made until after the death of the surviving spouse and only if there is no minor, blind or disabled child.

If an estate claim is filed you have a right to a hearing and waivers are
available in cases where recovery would cause undue hardship. Estate claims can be complicated. If you receive notice of an estate claim contact your attorney, local legal services office or other Medi-Cal professional.

The best way to avoid an estate claim is not to have anything in your estate when you die. As noted earlier, by declaring an intent to return home, a nursing home resident will retain his or her home as an exempt asset, and exempt assets may be transferred without affecting Medi-Cal eligibility. Any transfers considered should take place before or as soon as possible after an individual enters a nursing facility. Transfers should be reviewed with a qualified, Medi-Cal knowledgeable "expert" or estate planning attorney.

For information regarding Medi-Cal planning experts please call Seniors First.