Garland Law Offices, P.A.

Combining Households during Coronavirus

“If family members are anxious about each other, sometimes it seems it might be easier if they simply joined households. This is not just due to COVID-19.”

Not that long ago, multigenerational living was how most people lived.  Since people are living longer, it may become the norm again. In times of crisis like these, says the article “Moving ahead during coronavirus,” from The Mercury, many parents and adult children are combining family units to care for each other.

Parents might move in with their son or daughter’s family. The adult children and their spouse and children may also come to live with Mom and Dad. It is not just about parents and children, since siblings also decide it’s better for everyone to live closer.

If family members are considering combining households, they need to create a plan for important issues. Who will pay for what, what is the back up if the arrangement does not work and what boundaries will be set, so that the children and their parents have a sense of privacy?

Conversations about how this arrangement relates to the parent’s overall estate plan also need to take place. Will parents fund the entire household, if one or more adult children are not working? Will there be expectations of eventual re-payment? How does the household pay its bills and who will be responsible for what chores?

An important question to address, is the issue of a parent’s gifting assets to the adult child. If the long-term plan is for the parent to apply for Medicaid, it will be important to plan any asset transfers to avoid having the parent become ineligible for long-term care coverage.

It’s easy for this kind of joint living arrangement to be derailed by misunderstandings and expectations that are not discussed. Writing out a document with the help of an estate planning attorney can make the discussion more concrete and ensure that the agreement will complement and not conflict with the estate plan. Every situation is different, and what works for one family may not work for another. Having an outside professional involved can reduce the emotional aspect and clear the way for a happy arrangement that works for everyone.

Reference: The Mercury (July 28, 2020) “Moving ahead during coronavirus”

When Social Security Makes the Most Sense

“When should you sign up for Social Security? It is a good question. Many seniors grapple with that decision, and understandably so, since the age at which you claim benefits will dictate how much money you will receive each month during retirement.”

There’s an unfortunate tendency to focus on how to get the most out of Social Security in total benefits, but that’s not always the right approach to determine when to apply for Social Security. Everyone has the same eight-year window—from age 62 to 70—when they can start applying for benefits, as explained in the article “Why Claiming Social Security at 65 Is a Smart Bet” from The Motley Fool. The year you were born determines when Social Security sets your Full Retirement Age, or FRA.

Whether you take Social Security at age 62, which is the earliest you can take it, or at 70, after which you’ve maxed out on monthly benefits and there’s no reason to delay, depends on many different factors. For example, do you expect to live a long time based on your family history? If so, it may make sense to wait. However, if you have a number of health conditions and expect to have a shorter life span, then take your benefits early and enjoy them—you earned them.

The most common age for starting Social Security benefits is at age 62. A much smaller percentage of seniors wait until age 70 to collect benefits. Doing so locks in a higher benefit for life, but if you don’t live much longer than 70, the benefit doesn’t matter quite as much.

Going from one extreme to the other points to a choice in the middle: age 65. That’s when Medicare kicks in. Some people get these benefits confused. They think that once they are eligible for Medicare, they are eligible for full Social Security benefits. This is not true. However, 65 is still a good age to start taking Social Security benefits for a few reasons.

• You’re not taking Social Security at the earliest age possible, so you have had two years for your benefits to increase.
• You’re not taking Social Security at the latest age. Therefore, if you don’t live into your 90s, you’ll still have had those years to enjoy the fruits of your labor.

The numbers-crunchers at Social Security work to make sure that everyone gets the same lifetime benefits, regardless of when they file. The logic is simple: claim early, and get a smaller benefit, possibly for a longer lifetime. Delay your claim, and the same amount of money in total will come to you, just in fewer payments.

There is another advantage for claiming Social Security around the same time you switch over to Medicare. Your Part B premiums will be directly paid from Social Security benefits. That means you’ll have some protection against rising premiums. That’s because of what’s known as the “hold harmless provision.” It is a provision that attempts to limit how much of a bite Medicare premiums can take out of Social Security benefits. It’s not a perfect solution, but it’s a little bit of a help.

Reference: The Motley Fool (July 10, 2020) “Why Claiming Social Security at 65 Is a Smart Bet”

Your Estate Plan Needs to Be Customized

“Estate planning documents often are treated like the photocopied permission slip for a child’s field trip. You fill in your name, include the children’s names and dates of birth and sign. The document is filed away to be used if needed, but you really never expect it to be used.”

The only thing worse than having no estate plan, is an estate plan created from a ‘fill-in-the-blank’ form, according to the recent article “Don’t settle for a generic estate plan” from The News-Enterprise. Compare having an estate plan created to buying a home. Before you start packing, you think about the kind of house you want and how much you can spend. You also talk with real estate agents and mortgage brokers to get ready.

Even when you find a house you love, you don’t write a check right away. You hire an engineer to inspect the property. You might even bring in contractors for repair estimates. At some point, you contact an insurance agent to learn how much it will cost to protect the house. You rely on professionals, because buying a home is an expensive proposition and you want to be sure it will suit your needs and be a sound investment.

The same process goes for your estate plan. You need the advice of a skilled professional–the estate planning lawyer. Sometimes you want input from trusted family members or friends. There other times when you need the estate planning lawyer to help you get past the emotions that can tangle up an estate plan and anticipate any family dynamics that could become a problem in the future.

An estate planning attorney will also help you to avoid problems you may not anticipate. If the family includes a special needs individual, leaving money to that person could result in their losing government benefits. Giving property to an adult child to try to avoid nursing home costs could backfire, making you ineligible for Medicaid coverage and cause your offspring to have an unexpected tax bill.

Your estate planning lawyer should work with your team of professional advisors, including your financial advisor, accountant and, if you own a business, your business advisor. Think of it this way—you wouldn’t ask your real estate agent to do a termite inspection or repair a faulty chimney. Your estate plan needs to be created and updated by a skilled professional: the estate planning lawyer.

Once your estate plan is completed, it’s not done yet. Make sure that the people who need to have original documents—like a power of attorney—have original documents or tell them where they can be found when needed. Keep in mind that many financial institutions will only accept their own power of attorney forms, so you may need to include those in your estate plan.

Medical documents, like advance directives and healthcare powers of attorney, should be given to the people you selected to make decisions on your behalf. Make a list of the documents in your estate plan and where they can be found.

Preparing an estate plan is not just signing a series of fill-in-the-blank forms. It is a means of protecting and passing down the estate that you have devoted a lifetime to creating, no matter its size.

Reference: The News-Enterprise (June 23, 2020) “Don’t settle for a generic estate plan”

Handing Kids Keys to Your Home Is Never Good Estate Planning

“Adding an adult child to your house deed, or giving them the home outright, might seem like a smart thing to do. It usually isn’t.”

Transferring ownership of the family home to an adult child may seem like a simple approach for avoiding having the house go through probate, or even qualifying easily for Medicaid. However, this seemingly simple solution comes with many problems, including taxes and the potential for years of delay for qualifying for Medicaid. That’s the advice from the article “Don’t Give Your Adult Kids Your House” from Nerd Wallet.

There are many other ways to transfer a house to family members. Estate planning lawyers will be able to help you accomplish this, without creating extra problems for your family.

First, if you leave the house to your children in your will, which means they don’t get it until you die, they receive something called a “step-up in basis.” This means that all of the appreciation of the house that occurred during the time that you owned the house until your death is not taxed.

Here’s an example. A financial planner advises his client not to let his mother gift him the family home. She paid $16,000 for it back in 1976, and the current market value of the house was close to $200,000. None of that increase in value would be taxable if the son inherited the house. However, she signed a quitclaim to give her son the house while she was living and died shortly afterwards. The estimated tax bill was about $32,000.

Some families who realize the impact of this when it’s almost too late, scramble to give the house back to the parents. They do a last-minute deed change, before it’s too late. There isn’t always time for this.

When it comes to transferring the house, so a parent can qualify for Medicaid, there’s a five-year look back that prohibits any transfer of assets, especially of a house. That can lead to a penalty period, so the senior who needs long-term care will not be eligible for Medicaid.

Transferring a home to an adult child with financial or marital problems is asking for trouble. If the house becomes the child’s asset, then it can be attached by creditors. If a divorce occurs, the home will be an asset to be divided by the couple—or lost completely.

As for the family in the example above, the man was almost stuck paying taxes on a $184,000 gain. A tax research firm he engaged learned of a workaround, Section 2036 of the Internal Revenue Code. If the mother retained a life interest in the property, which includes the right to continue living there, then the home would remain in her estate, rather than be treated as a completed gift. The son, as executor of the estate, filed a gift tax return on her behalf to show that he was given a “remainder interest” or the right to inherit, when his mother’s life interest expired at her death.

There are less stressful and less costly ways to avoid the family home being part of the probated estate. Let an experienced estate planning attorney help your family before costly, time-consuming and stressful mistakes are made.

Reference: Nerd Wallet (April 3, 2020) “Don’t Give Your Adult Kids Your House”

The High Cost of Medicare Mistakes

“She recently enrolled in traditional (Parts A, B, and D) Medicare and was hit with huge Part B and Part D monthly premiums. She had no idea why it was so high. After many letters, calls, and meetings with Social Security, she still had no idea.”

A 68-year-old woman knew that she had to sign up at age 65 for Medicare Part A for hospital care and Part B for outpatient care, since she did not have employer provided health insurance from an employer with 20 or more employees. She knew also that if she did not have health insurance from an employer and didn’t sign up immediately, she’d face a penalty with higher Part B and Part D premiums for the rest of her life when eventually she did sign up, reports Forbes in the article “Beware Medicare’s Part B Premium Penalty And Surcharge Traps.”

Here’s where it got sticky: she thought that Medicare provided an eight-month special enrollment period after one job ended to apply penalty free. She is employed on a sporadic basis, so she thought she had a window of time. Between the ages of 65 and 68, she had several jobs with large employers, and was never out of work for more than eight months.

She was out of work for 25 months total between ages 65 and 68, when she was not enrolled in Medicare. She thought that since she was never out of work for more than eight months, she didn’t have to sign up until she officially stopped working and would then enroll penalty free in traditional Medicare Parts A, B, and D.

She had read information on the Medicare website and her interpretation of the information was wrong. It was a costly mistake.

In determining whether you need to permanently pay a Medicare Part B penalty, Medicare counts up all the months between age 65 and the month you first enroll in Part B, even if you have a job with a large employer with no gaps in employment for more than eight months.

She got hit with a 20% lifetime Medicare Part B premium penalty. For every 12 months that you’re not covered by Medicare B after reaching 65 and before you enroll, the penalty is an additional 10%. And making things worse, she was hit with a Medicare Part B penalty based on the cumulative (not consecutive, which is an important difference) 25 months that she went without credible prescription drug coverage.

This is the sort of problem that does not self-resolve or get better over time. In this case, another mistake in timing is going to hurt her. She sold some assets and realized a capital gain in 2018, which increased her Modified Adjusted Gross Income (MAGI). In 2020, she’s going to have to pay the Income Related Monthly Adjustment Amount (IRMAA). If your MAGI, two years before the current year, is less than $87,000, you are exempt from IRMAA in the current year. Her cost: $1,735.20 more this year. Had she instead realized those capital gains over the course of several years, her 2018 MAGI might not have crossed the $87,000 threshold. Most people are not aware of the IRMAA and take capital gains in larger amounts than they need.

This is a harsh lesson to learn, at a time in life when there’s not a lot of flexibility or time to catch up. Talking with an estate planning lawyer about Medicare and about tax planning, as well as having an estate plan created, would have spared this woman, and countless others, from the harsh consequences of her mistakes.

Reference: Forbes (Jan. 29, 2020) “Beware Medicare’s Part B Premium Penalty And Surcharge Traps”

Is Medicare Coverage Free?

“After paying into Medicare through payroll withholding for many years, you might think your coverage will be free once you turn 65. You’d be wrong.”

Medicare has a variety of expenses—including premiums, copays and deductibles. CNBC’s recent article, “Here’s what you should know about Medicare costs if you’re nearing age 65,” found that half of respondents in a recent poll by consumer website eligibility.com, said they believe Medicare is free.  If you fail to sign up on time, you may face penalties for the rest of your life.

Fidelity Investments estimates that the average male-female couple will spend at least $285,000 on health care in retirement. The items not covered by Medicare—dental, basic vision, over-the-counter medicines, long-term care—would be in addition to that amount.

If you have at least a 10-year work history, you pay no premiums for Medicare Part A. This will cover hospital stays, skilled nursing, hospice, and some home health services. However, Part A has a deductible of $1,364 per benefit period and some caps on benefits. Part B—which covers outpatient care and medical supplies—has a standard monthly premium of $135.50 (in 2019). Higher earners pay more. This part has a $185 deductible (for 2019). After it’s satisfied, you typically pay 20% of covered services.

Those parts of Medicare don’t cover prescriptions, so a Part D drug plan is needed.

You can get a separate plan to use with original Medicare, or you can enroll in an Advantage Plan (Part C). This plan usually has prescription drug coverage. If you go with this, your Parts A and B benefits also will be delivered through the insurance company offering the Advantage Plan.

The average cost for Part D coverage in 2019 is $32.50 per month, according to the Centers for Medicare and Medicaid Services. However, high earners pay extra for their premiums. The deductible for 2019 is $415.

If you accessed your Social Security benefits before age 65, you’ll automatically be signed up for original Medicare. A month or two before you turn 65, you’ll be automatically enrolled, and your card will be delivered in the mail. You’ll see your Social Security check decreased by the cost of the Part B premium.

If you haven’t yet used Social Security, you must enroll proactively. There’s a seven-month enrollment period that begins three months before your birthday month and ends three months after it. If you have insurance through an employer when you reach age 65, you may be able to wait to enroll in Medicare without a penalty.

Even if you don’t take medicine right now, at least sign up for the cheapest drug plan just so you don’t face a penalty. This is because if you don’t enroll in Part B when you’re supposed to, you’ll see a 10% penalty for each year that you should’ve been enrolled. The amount would be in addition to your monthly premium. Part B enrollment isn’t required, if you have medical coverage from your job.

As far as Part D, the penalty for not enrolling when you were first eligible is 1% for every month that you could have been signed up—unless you have qualifying coverage through an employer’s plan.

Many people couple their original Medicare benefits with a supplemental policy—known as Medigap—to help cover out-of-pocket costs like deductibles and coinsurance. However, you can’t pair a Medigap policy with an Advantage Plan.

If you select an Advantage Plan, there may be limited coverage for dental and vision.

Reference: CNBC (August 29, 2019) “Here’s what you should know about Medicare costs if you’re nearing age 65”

Can I Deduct Long-Term Care Expenses on My Tax Return?

“The staggering costs of long-term care can wreak havoc on your retirement savings. According to the U.S. Department of Health and Human Services, about 27% of Americans turning 65 this year will incur at least $100,000 in long-term-care costs, while 15% will require care costing more than $250,000. That’s a hard pill for most seniors to swallow.”

If you need long-term care, you may be able to deduct some of the costs on your tax return. If you purchased a long-term-care insurance policy to cover the costs, you may also be able to deduct some of that. Retirement planning entails long-term care, so it’s critical to know how these tax deductions can help offset overall costs.

Kiplinger’s recent article, “Deduct Expenses for Long-Term Care on Your Tax Return,” explains that you can deduct unreimbursed costs for long-term care as a medical expense, including eligible expenses for in-home, assisted living and nursing-home services. However, certain requirements must be met. The long-term care must be medically necessary and can include preventive, therapeutic, treating, rehabilitative, personal care, or other services. The cost of meals and lodging at an assisted-living facility or nursing home is also included, if the main reason for being there is to get qualified medical care.

The care must also be for a chronically ill person and given under a care plan prescribed by a licensed health care practitioner. A person is “chronically ill,” if he or she can’t perform at least two activities of daily living—like eating, bathing or dressing—without help for at least 90 days. This condition must be certified in writing within the past year. A person with a severe cognitive impairment is also deemed to be chronically ill, if supervision is needed to protect his or her health and safety.

To claim the deduction, you must itemize deductions on your tax return. Itemized deductions for medical expenses are only allowed to the extent they exceed 10% of your adjusted gross income in 2019. An adult child can claim a medical expense deduction on his own tax return for the cost of a parent’s care, if he can claim the parent as a dependent.

The IRS also permits a limited deduction for certain long-term-care insurance premiums. You must submit an itemized deduction for medical expenses, and only premiums exceeding the 10% of AGI threshold are deductible in 2019. Further, the insurance policy itself must satisfy certain requirements for the premiums to be deductible. For instance, it can only cover long-term-care services. This limitation means the deduction only applies to traditional long-term-care policies, rather than hybrid policies that combine life insurance with long-term-care benefits. The deduction has an age-related cap.

These deductions are typically not useful for people in their fifties or sixties but can be valuable for people in their seventies and older. That’s because income tends to drop in retirement, so the deductions can have a greater overall impact on tax liability. As you age, you’re also more likely to have medical expenses exceeding 10% of AGI. Those deductions could move your total itemized deductions past the standard deduction amount. The chances of satisfying the medical necessity requirements for the care costs deduction also increase with age, and the cap for the premium deduction levels off after age 70.

Reference: Kiplinger (September 4, 2019) “Deduct Expenses for Long-Term Care on Your Tax Return”

When Should I Review My Estate Plan?

“An estate plan is the guide to how you want your personal and financial affairs to be handled, in the event of your incapacity or death.”

As life changes, you need to periodically review your estate-planning documents and discuss your situation with your estate planning attorney.

WMUR’s recent article, “Money Matters: Reviewing your estate plan,” says a common question is “When should I review my documents?”

Every few years is the quick answer, but a change in your life may also necessitate a review. Major life events can be related to a marriage, divorce, or death in the family; a substantial change in estate size; a move to another state and/or acquisition of property in another state; the death of an executor, trustee or guardian; the birth or adoption of children or grandchildren; retirement; and a significant change in health, to name just a handful.

When you conduct your review, consider these questions:

• Does anyone in your family have special needs?
• Do you have any children from a previous marriage?
• Is your choice of executor, guardian, or trustee still okay?
• Do you have a valid living will, durable power of attorney for health care, or a do-not-resuscitate to manage your health care, if you’re not able to do so?
• Do you need to plan for Medicaid?
• Are your beneficiary designations up to date on your retirement plans, annuities, payable-on-death bank accounts and life insurance?
• Do you have charitable intentions and if so, are they mentioned in your documents?
• Do you own sufficient life insurance?

In addition, review your digital presence and take the necessary efforts to protect your online information, after your death or if you’re no longer able to act.

It may take a little time, effort, and money to review your documents, but doing so helps ensure your intentions are properly executed. Your planning will help to protect your family during a difficult time.

Reference: WMUR (January 24, 2019) “Money Matters: Reviewing your estate plan”

What Are Some of the Myths About Caregiving Costs?

“Decipher the fine print when caring for a loved one.”

The financial aspects of caring for an aging loved one can frequently be a gray area. It can be hard to predict upcoming health-related expenses and estimate how much assistance will be needed. However, the costs of caregiving tend to run high, and the value of family and friend caregiving amounts to about $470 billion each year, according to an AARP Public Policy Institute report.

U.S. News & World Report says, in “7 Myths About Caregiving Costs,” if you’re currently providing care for a senior or plan to do so in the future, sifting through the financial details as early as possible can save time and money in the long term. Let’s look at some common misconceptions concerning the costs of caregiving, as well as the realities to expect.

Your relative will stay at home and not have caregiving expenses. While your aging relative may never move to an assisted living facility, other care-related costs could still arise because many adult children take on the responsibilities for their aging parent gradually. You eventually may need to bring in skilled nursing support or arrange for in-home care. Even if your senior never lives outside of his own home, responsibilities like these define the role of a caregiver, and costs creep up over time.

All home help will be paid for by insurance. You may think that health insurance or Medicare will pay for all of the costs. However, in most instances, you'll need to find other funds for daily help at home. Health insurance and Medicare never pay for custodial care.

It’s easy to figure out how much assistance at home will cost. The precise amount your loved one or family will spend on bringing in home assistance can vary significantly. It really depends on the level of care needed, along with whether a patient has long-term care insurance or any other form of long-term insurance, where they live and if they qualify for Medicaid. The cost can also vary based on the family situation where relatives are available to help on certain days, reducing the amount needed to pay for professional caregiving assistance.

The cost of caregiving is merely financial. If you’re taking hours every week of your days caring for a loved one, you may experience struggles in other areas of your life. This could mean you have little time for other family and friends, sleep or exercise. These can lead to non-financial costs like increased stress, your own health problems and the emotional strain of caring for an aging loved one.

You can’t afford a caregiver, so you're not going to get one. If your aging parent has few financial resources or other family members can’t help pay for professional care, you should look at what other resources may be available.

Caregiving won’t affect your own finances. Sorry, but helping a loved one may entail additional physical demands that can affect your career and your financial status. Caregivers often work less hours, forfeit promotions, change jobs and even leave the workforce.

A discussion about finances can wait until care is warranted. Not so. If your loved one is now in good health and living at home, it can still be a wise idea to plan, so that if a crisis such as an accident occurs, everyone is ready.

Start a financial discussion with your senior with a few simple questions, perhaps asking for guidance for your own retirement to set things in motion.

Reference: U.S. News & World Report (Dec. 12, 2018) “7 Myths About Caregiving Costs”

What Type of Things Can’t a Nursing Home Do?

“People who reside in nursing homes are in a vulnerable position, since they are in need of near-constant assistance–not just with medical and health problems, but also, often, for daily living activities. Federal and state laws exist to safeguard nursing home residents’ care. However, your ability to protect yourself or your loved one during a short- or long-term nursing home stay, depends in part on knowing what these facilities are not allowed to do and what action to take if a violation occurs.”

 

Investopedia’s recent article, “Things Nursing Homes Are Not Allowed to Do” cautions that the discussion points in its article apply specifically to skilled nursing facilities, that are defined by Medicare as a special facility or part of a hospital that provides medically necessary professional services from nurses, physical and occupational therapists, speech pathologists and audiologists. They don’t apply to assisted living facilities or retirement homes.

Discrimination. Federal law prohibits skilled nursing facilities from making a decision about whether someone can live there based on race, color, religion, age, sex or any other protected characteristic.

Services Provided. A skilled nursing facility must state in writing the types of services it will provide and fees before a patient moves in. Some types of retirement facilities, like continuing care communities, also require a large buy-in fee up front that guarantees residents access to various levels of care as their needs change, but skilled nursing facilities can’t charge those fees.

Health Assessment. When a patient first enters a nursing home, he is given a health assessment. These assessments continue daily for the length of his stay. The medical staff will evaluate the patient’s physical and mental health, medications, ability to take basic care of himself and ability to speak and make decisions. The assessments are used to plan treatment, evaluate progress and determine ongoing eligibility for Medicare coverage. Residents can participate in their care plan, and if they’re not able to do so, an adult child can participate on their behalf.

Money Management. A nursing home may offer to manage a resident’s personal funds as part of its services, but it can’t require a resident to let it manage their money, and it cannot do so without the resident’s written consent. When approved, the nursing home must provide quarterly financial statements and cannot prevent residents from accessing their bank accounts, cash or financial documents. If a resident deposits more than $50 into a managed account, that account must pay interest.

Dignity and Respect. Federal law states that nursing home residents have the right to be treated with dignity and respect. This includes making decisions on the time they want to go to bed and when they get up; what time to eat; and what to do during the day, provided their decisions don’t conflict with the care plan. Residents cannot be verbally or physically abused, medicated with drugs that aren’t in their treatment plan, restrained physically (unless they pose a danger to themselves or others), involuntarily isolated or to have their property used or taken by anyone else at the facility. Patients have the right to privacy and to personal property—this means being allowed to open their own mail and to have private phone conversations.

Visitation. Patients can have visitors during reasonable times of day. They’re also allowed to refuse visitors they don’t want to see. Family members must be allowed to have access to the patient at any time (unless the patient says otherwise).

Physical Condition. Even though a patient is in poor physical or mental health, she has the right to be told her physical condition; her diagnoses; and the types of medications she’s been prescribed. She also has a right to see her medical records. Patients can continue to see their own doctors, meaning they don’t have to accept the services of practitioners provided by the nursing home. Patients also have the same right to refuse treatments and medications that outpatients do. If a patient needs mental, legal, or financial counseling concerning her treatment, the nursing home must provide these services.

Medicare Benefits. Nursing homes don’t have to keep track of the Medicare benefits being used to pay for a patient's care. When it comes to facilities, Medicare coverage can be complicated because it covers a stay completely for a certain number of days but then pays a set amount for an additional period and all this only under certain conditions. After that, patients are responsible for the whole bill, unless they have long-term care insurance or some other form of coverage.

The nursing home doesn’t have to notify a resident that the benefit days are ending, and it can continue to charge them for their care. The one exception is if Original Medicare benefits stop earlier than expected, because the care is deemed no longer “medically reasonable and necessary.” In that case, the nursing home must notify the patient that coverage is ending, when it’s ending and why. The nursing home must also tell such patients that they’ll be responsible for further costs and how much it estimates those costs will be. But a facility usually can’t require another family member to pay for a resident’s care.

Discharge Planning. Nursing homes must help with discharge planning, and they generally can’t discharge a patient or transfer him to another facility without his consent, unless:

• the patient’s health has declined to the stage, where the facility can no longer meet his needs;
• the patient has improved to the point, where he no longer requires the facility’s services; or
• the patient poses a threat to his own welfare or that of other residents.

In addition, a resident can be discharged for not paying the facility’s bills (but not when the delinquency is caused by waiting for Medicaid payments from the government).

Complaints. Residents and their advocates have a right to complain about any issue they have in a nursing home, and nursing homes can’t punish someone for doing so.

Ability to Sue. A 2016 regulation gave nursing home residents and their families the ability to sue any nursing home that receives federal funding. Before this, nursing homes could try to force people into arbitration, and any quality of care and safety issues could be kept private. However, a preliminary injunction granted in Mississippi in late in 2016 put this regulation on hold for now.

New Rules. There are new rules that give nursing home residents more rights. Residents will be allowed to receive any visitor, not just relatives, at any hour of the day, provided visitors don’t disturb fellow residents. Residents who want to live together will be permitted to do so, and nursing homes will have greater responsibility for ensuring that residents’ personal belongings aren’t lost or taken. In addition, nursing homes will be required to provide meals and snacks when residents want them, rather than only at set times. Staff will get more training in caring for dementia patients and preventing elder abuse, and nursing homes won’t be able to easily discharge residents with dementia, by sending them to a hospital and then refusing to readmit them.

In effect, a person’s rights as a nursing home resident should be the same as the rights she had outside the facility.

Reference: Investopedia (September 30, 2018) “Things Nursing Homes Are Not Allowed to Do”