How Much Does Medicare Pay for Nursing Home Stays?

How Much Does Medicare Pay for Nursing Home Stays?

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According to the AARP, the median monthly cost to live in a nursing home is $7,908 for a semi-private room. The options for paying for such care are limited. Fortune’s recent article, “Does Medicare pay for nursing home care? An expert helps make sense of the rules,” reminds us that there’s limited nursing home coverage under Medicare.

Medicare won’t pay for nursing home care but for certain stays under specific conditions. The program will pay for a nursing home stay, if it’s determined that the patient needs skilled nursing services, like help recovering after a medical issue like surgery or a stroke, but for not more than 100 days. For the first 20 days, Medicare will cover 100% of the cost. From day 21 to 100, the patient pays a $200 co-payment in 2023, and Medicare pays the balance.

To qualify, the individual would need at least a three-day stay as a hospital inpatient before the agency would approve payment for nursing home care for rehabilitation or skilled nursing care. Getting three days as an inpatient in a hospital is a challenge as hospitals are discharging patients quickly, and most patients aren’t staying for three nights. Hospitals also use what’s called observation status, where a patient is technically not admitted to the hospital. This affects beneficiaries’ ability to access Medicare coverage for rehabilitation or skilled nursing care in a nursing home. Observation status gives physicians 24-48 hours to assess if a patient should be admitted for inpatient care or discharged. This status can be costly for Medicare patients as the agency classifies it as outpatient care. As a result, beneficiaries may have to pay their share of that cost as a deductible, coinsurance, or copayment. Some patients also remain in observation status longer than the typical 24 to 48 hours.

To address this, Medicare has implemented the two-midnight rule. This rule stipulates that when a physician expects a patient to require hospital care for at least two midnights, they should admit them as an inpatient. However, two midnights spent under observation don’t count toward the three-day inpatient stay patients need to qualify for coverage in a nursing home or SNF. It’s not just a matter of the time spent in the hospital; it’s how the patient is classified.

The patient must be formally admitted as an inpatient to be classified as an inpatient.

Because each state regulates Medicaid eligibility differently, ask an experienced elder law attorney to guide you through the process and to help you find the best long-term care option.

Reference: Fortune (Aug. 29, 2023) “Does Medicare pay for nursing home care? An expert helps make sense of the rules”

What Should I Know About Stroke Recovery?

A stroke is a serious medical emergency that happens when blood flow is deficient to an area of the brain or bleeding in the brain. Sometimes, direct stroke intervention is necessary. This may include:

Blood thinners given intravenously (IV) for an ischemic stroke;
Direct injection of blood thinners into a blood clot for certain types of ischemic strokes;
Thrombectomy, where a thin tube (catheter) is threaded through blood vessels to a clot in the brain, and the clot is mechanically removed;
Surgical intervention for removal of blood for a hemorrhagic stroke; and
A craniotomy removes a small area of the skull to relieve severe edema (swelling).

VeryWell Health’s recent article, “Everything You Should Know About Stroke,” explains that close monitoring of neurological functioning, fluid and electrolyte concentration, blood pressure and blood glucose is needed in the first few days after a stroke. Brain damage from a stroke may sometimes cause a seizure, necessitating treatment with antiepileptic medication.

After stabilization, recovery can start, but note that recovery after a stroke is often gradual. Some people fully recover, but most have some impairment after a stroke.

Immediate medical care and consistent therapy can improve long-term outcomes. Patience throughout recovery is important because improvement doesn’t always adhere to a smooth and steady path.

Sometimes, complications can be prevented by taking proactive measures. Choking or pneumonia, possibly due to difficulty swallowing, is an especially concerning risk. Weakness and sensory changes can increase the chances of bedsores and blood clots. Weakness and vision changes may lead to falling after a stroke.

Rehabilitation should be customized to specific deficits that happen after a stroke. For example, many people require physical therapy to help with improving muscle control and strength. Speech and swallow therapy is crucial to avoid choking and aspiration pneumonia.

Recovery can frequently be slow over the next few weeks. For some, recovery continues for up to a year.

Reference: VeryWell Health (Feb. 27, 2023) “Everything You Should Know About Stroke”

How Do I Make a Care Plan for Mom?

Medicare typically doesn’t pay for basic assistance, and families often don’t try to determine how to provide this care until there is a health crisis, which can lead to unnecessary stress, conflicts and escalating costs.

Nerd Wallet’s recent article, “Create a Care Plan for Older Parents (or Yourself),” says that making a care plan well in advance lets families organize, locate appropriate resources and determine ways to pay for care before a crisis hits.

A care plan is thinking through the logistics of what you’ll need as you age, so that you are prepared when the poop hits the fan with aging. A way to cope is to plan for temporary rather than permanent disability. Ask what kind of help you or your loved one might need after a hip or knee replacement. How well is the home set up for recovery? Who would help with household tasks? Contemplating a two- or three-month disability with an eventual return to health is less daunting but involves much of the same planning as a more lasting decline.

Many seniors would like to stay in their current homes as they age, something called “aging in place.” That typically means relying on family members for care, using paid workers, or both. However, if family members will be tapped, discuss the logistics, including whether and how much they will be paid. If home health aides will be hired, consider who will supervise the process.

Look at any savings that can be tapped and whether the senior may qualify for government help, such as veterans benefits, Medicaid, or state programs. Families may want to consult an elder law attorney for personalized advice.

It is important to look at the current home as “aging friendly.” An occupational therapist can suggest adaptations allowing the older person to remain in the home if they’re disabled. The sooner you get this evaluation, the more time you’ll have to prepare. Even if the home supports aging in place, the neighborhood might not. Consider how the older person will socialize, get groceries, and make it to health appointments if they can no longer drive.

An independent living or senior living facility could provide more amenities. However, these typically don’t provide long-term care. Therefore, see if the senior is okay with moving again later or whether they should begin with an assisted living or continuing care facility that can provide more help.

Once you have a plan, capture the details and share it with family members or others who may be involved. Revisit the document periodically as circumstances change. Aging planning is an ongoing process.

Reference: Nerd Wallet (Aug. 24, 2023) “Create a Care Plan for Older Parents (or Yourself)”

What Is the Latest on Picasso’s Estate?

Claude Ruiz Picasso, Pablo Picasso’s youngest son, has died at the age of 76.

The Art Newspaper’s recent article, “Claude Ruiz Picasso, the artist’s son and manager of the Picasso estate, has died,” reports that as the long-term manager of his father’s estate, Claude was the holder of the Picasso copyright. He was also instrumental in organizing Picasso Celebration 1973-2023, a compendium of 50 exhibitions of Picasso’s work, shown in cultural institutions across Europe and the US over the course of 2023 to mark 50 years since Pablo Picasso’s death.

Claude transferred management of the estate in July of this year to Paloma Ruiz Picasso, his younger sister. He was originally appointed by a court as the administrator of the Picasso estate in 1989. The Picasso estate remains one of the most valuable collections in the art world, numbering around 45,000 pieces. At the time of Pablo Picasso’s death in 1973, the estate was estimated to be worth $817m.

In the commercial art world, art is frequently subject to forgery, fake usage, and criminal trading. In the copyright and trademark sectors, the Picasso estate has often set legal precedents regarding its willingness to pursue legal action against counterfeit, illegal reproduction, and forgery cases to protect the artist’s legacy.

Claude was the son of Pablo and the French painter Françoise Gilot, who also died in June of this year at the age of 101. Gilot is often known as the only woman who left him. Pablo tried to legally stop her, 40 years his junior, from publishing a memoir of her life that detailed her experience of being in a relationship with him, including testimonies of abuse, including an occasion when he held a lit cigarette against her cheek. The book was eventually published in 1964.

Pablo severed contact with both Claude and Paloma after the book’s publication and never contacted them again.

Before he was appointed the manager of the Picasso estate, Claude was an artist in his own right. Living in New York, he worked briefly as an assistant to the photographer Richard Avedon before seeing his own photographs published in fashion magazines, including Vogue and Time Life.

Reference: The Art Newspaper (Aug. 25, 2023) “Claude Ruiz Picasso, the artist’s son and manager of the Picasso estate, has died”

Should I Enroll in Medicare Before I Retire?

A recent survey found that a third of those nearing retirement age (62-64) who plan to keep working past 65 don’t understand they can sign up for what is often more affordable Medicare coverage, even while they’re still employed.

Kiplinger’s recent article, “Yes, You Can Sign Up for Medicare While You’re Still Working,” says that with retirement further away for many, some people must get some help understanding their options. The article answers some common questions concerning retirement postponement and Medicare coverage, including common misperceptions.

Your retirement decision is personal and dependent on your situation. Access to health coverage is one of the primary reasons that the average age at which people retire is going up. In a survey of more than 1,000 American older workers, 31% of those with employer insurance say health care is their primary reason for working, and 53% say it’s one factor. Whether you are continuing to work based on career fulfillment or health coverage, having a plan in place for handling your Medicare decisions before you turn 65 can streamline the transition off of your employer-sponsored health insurance.

Most working seniors don’t have to enroll in Medicare. It’s not required that all seniors make the jump as soon as they hit 65. However, there are some situations where it’s mandatory. It is important to be aware of these exceptions to ensure that there are no gaps in your coverage. If you delay your signup, you might end up paying for it: your small company’s group plan can deny your claims if they find you’re eligible for Medicare. There are also financial penalties for late enrollment, so if you work for a small company, you must be ready to make the leap to Medicare coverage, regardless of your retirement plans.

Employees approaching retirement and those who have reached retirement age say they’re mostly happy with their employer health benefit packages. However, hesitation and misconceptions about Medicare prevent workers from shopping for better plans. If Original Medicare is unaccompanied by a prescription drug plan (Part D) or a Medigap supplement, it may be less than your current employer-sponsored level coverage. Most individuals who sign up for Medicare don’t sign up for Original Medicare alone. You should couple your Original Medicare plan with a prescription drug and Medigap plan. Each Medigap plan (plans A to N) offers a different level of coverage that demands careful consideration in terms of weighing which plan best fits your needs.

Another option, aside from Original Medicare plus a Medigap plan, would be to go with a Medicare Advantage plan (Part C). Medicare Advantage plans are usually less expensive, and some plans have no monthly premium.

Reference: Kiplinger (Oct. 11, 2022) “Yes, You Can Sign Up for Medicare While You’re Still Working”

How can You Make Changes to Estate Plan?

It’s rare for a person to put their estate plan together once and never change it. A recent article from Coeur d’Alene/Post Falls Press asks a good question: “Can you amend your estate plan by writing the changes on your existing documents?”

Effectively and legally changing your will or trust so the changes are enforced per your wishes is best done with an experienced estate planning attorney. People often hand-write edits and changes to the original documents, thinking this is the simple way to amend their wishes. Most attorneys have tales of family members coming into their offices with a handwritten addendum added to the front or back of a will or trust document, which has been written and attached after the document has been signed and executed.

These approaches are problematic, as they are never done in a way that meets the requirements for a legally valid amendment to a will or trust.

A legally enforceable change to a will is accomplished in one of two ways. One is to replace the entire document with a new will document, which should include explicit language stating all prior wills are revoked and replaced, or by adding a new document called a codicil to the old will document. The codicil must make clear exactly what part of the old document is being changed, and typically, it reaffirms the unchanged terms of the old will.

Changes to a trust are accomplished in most states in one of two ways. The first is by replacing the prior trust document with an entirely new trust document, although the name and creation date of the trust must remain the same, and it is explicitly not a revocation of the trust. This is called a trust restatement. The second way to change a trust is using a trust amendment, similar to adding a codicil of a will. A Trust Amendment is a new document added to the existing trust document. It states which part or parts of the original trust document are being changed.

Every state has specific technical requirements for a will codicil or trust amendment/restatement, which must be followed to enforce the changes legally. Just writing on the documents will never meet those requirements and will almost always lead to major disputes among family members and other interested parties.

Handwritten or holographic wills are legal in some states. However, those states have very specific requirements, and wills still need to go through probate. There are many ways to create major problems trying to use this method and only a few ways to do it right.

The good news is an experienced estate planning attorney can help with any modifications, large or small, to make your estate planning documents accurately reflect your wishes.

Reference: Coeur d’Alene/Post Falls Press (Aug. 16, 2023) “Can you amend your estate plan by writing the changes on your existing documents?”

Do I Pay Taxes When I Inherit?

Capital gains taxes are then calculated, so you pay taxes only on appreciation that occurs after you inherit the property. Yahoo Finance’s recent article entitled, “Do I Pay Taxes Automatically If I Inherit Property?” says there are three main types of taxes that cover inheritances:

Inheritance taxes are taxes that an heir pays on the value of an estate that they inherit. There are no federal inheritance taxes. However, six states have an inheritance tax.
Estate taxes are taxes paid out of the estate before anyone inherits. The estate tax has a minimum threshold, and as with all other tax brackets, the government only taxes the amount that exceeds this minimum threshold, which is $12.92 million ($25.84 million per married couple).
Capital gains taxes are taxes paid on the appreciation of any assets an heir inherits through an estate. They’re only levied when you sell the assets for gain, not when you inherit.

The cash you inherit is taxed through either inheritance taxes (when applicable) or estate taxes. With inheritance taxes, you must file and pay this tax.

With an estate tax, the IRS taxes the estate directly.

Therefore, it’s uncommon for an heir to owe any taxes, including income tax, on inherited cash.

The IRS does not automatically tax any other forms of property that you might inherit. However, you’ll owe capital gains taxes if you choose to sell this property.

When you inherit property, whether real estate, securities, or almost anything else, the IRS applies a stepped-up basis to that asset. This means that for tax purposes, the base price of the asset is reset to its value on the day that you inherited it. If you inherit property and immediately sell it, you’d owe no taxes on those assets.

Two prices are involved in establishing a capital gain tax: the sale price (how much you sold the asset for) and the original cost basis (how much you bought it for).

Reference: Yahoo Finance (Aug. 27, 2023) “Do I Pay Taxes Automatically If I Inherit Property?”

Why Is Stretching So Important?

Stretching — especially before bed — is an excellent aid for longevity. It has many benefits, from easing stress and improving sleep to reducing inflammation and menopause symptoms (among many more), says Livestrong’s recent article entitled, “Want to Age Well? Do This Every Night Before Bed.” Here are the benefits of stretching before bed for older adults (and everyone else), plus which bedtime stretches are best.

It Eases Stress. Stretching profoundly stimulates the body’s parasympathetic nervous system, which is responsible for resting, digesting, and healing the body. That’s why a mindful stretching practice before bed is an effective tool to help ground us and inhibit the sympathetic nervous system for better health.
It Reduces Inflammation. Regular stretching can have a great effect on decreasing inflammatory markers in the body. Gentle stretching at a low intensity can help you relax and stimulate the parasympathetic nervous system, which has an inflammatory regulating response.
It Can Improve Your Sleep Quality. Age is linked to difficulty falling and staying asleep. Therefore, winding down before bedtime can be challenging for many people. Stretching can also positively affect your sleep.
It Lowers Your Risk of Injuries (Including Falls). Stretching increases the force-length relationship of your muscles, so your muscles can both produce and manage a greater amount of force at various lengths. This can help decrease muscle and tendon-related injuries. Longer muscle lengths may allow the body to maintain balance and avoid falls, which is especially important as we age more effectively.
It Increases Blood Flow. Stretching can stimulate the parasympathetic nervous system, dilating the blood vessels to the muscle. Therefore, stretching would also theoretically increase blood flow to the muscles. That’s especially important because some older adults deal with blood flow-related health issues.
It Decreases the Frequency and Severity of Leg Cramps. Leg cramps are more common in older people because the tendons (the connective tissues that attach muscles to bones) shorten as you age. The frequency and severity of leg cramps also relate to poor hydration levels and nutrition deficiencies. Since older people are more likely to be dehydrated and lack certain essential nutrients, this puts them at a greater risk. Stretching at night may alleviate leg cramps.
It Helps With Menopause Symptoms. Light to moderate stretching can likely improve symptoms of menopause, such as hot flashes, sleep problems and mood fluctuations.

Reference: Livestrong (June 1, 2023) “Want to Age Well? Do This Every Night Before Bed”

Are CDs Good for My Estate Plan?

Certificates of deposit (CDs) are a low-risk way of saving funds for the short term and earning a modest return on it. When you take out a standard CD, your bank or credit union guarantees that they will pay you a set return on your money. In exchange, you agree to leave your money untouched in the account.

Investopedia’s recent article, “Can You Bypass Probate With CDs?” says that because CDs are a low-risk, time-constrained investment, they’re popular among seniors and often form part of inheritance settlements. When the owner of a CD passes away, it can be inherited in one of three ways. Therefore, it’s a way to pass on money without the CD going through probate.

CDs are treated like any other account as far as inheritance. While probate is frequently used to decide who will inherit particular assets after someone dies, other ways of passing on accounts can be much simpler and less expensive than probate.

There are three common ways to inherit property; only one involves probate. First, some property is jointly owned, passing directly to the co-owner without probate. This applies to joint accounts (including joint CDs) and real estate owned jointly.

The second category is contract property, like life insurance, retirement accounts and non-retirement accounts with beneficiaries designated upon death. These designations override instructions in the will and pass outside of probate directly to the named beneficiary. These accounts are often designated as payable on death (POD) or transfer on death (TOD). It is possible to add this designation to your CD account.

The third category is everything else. All property not covered above will generally have to go through probate.

If you want to avoid probate for the money you hold in your CD, there are two options available to you—you can either add a payable-on-death (POD) beneficiary to your account or hold it as a joint account. CDs can be held as joint accounts. However, the rules vary by state. In some states, if one joint account owner passes away, the other owner is automatically given full ownership of the account. If you inherit a CD in this way, it will typically continue to run in the way it was before. Once it reaches maturity, you can close it and withdraw the funds. In other states, if the joint owner of a bank account dies, the funds are divided between the surviving owner and the estate of the deceased.

Some CD accounts allow the owner to name a payable-on-death (POD) beneficiary. If the account owner dies, this person will automatically inherit the funds in a CD. These banks may terminate a CD when the account owner dies and allow the POD beneficiary immediate access to these funds. Other institutions will make them wait until the CD reaches maturity. In either case, the CD won’t have to go through probate.

Reference: Investopedia (August 23, 2022) “Can You Bypass Probate With CDs?”

How Can I Successfully Transfer My Business to My Children?

According to ITR Economics, out of the 77 million Baby Boomers in the U.S., an estimated 12 million are privately held business owners.

As ownership of businesses for those born between 1946-1964 is transferred to the next generation, an estimated $10 trillion worth of business assets is expected to be transferred in the coming years.

AZ Big Media’s recent article, “Passing the torch: Considerations for a successful generational business transfer,” explains the best way to have a successful business transfer.

Develop a Strategic Plan. A successful generational business transfer takes time and planning. You should begin the planning process way in advance of the change in leadership. This can give a family time to define what the future of the company looks like. Determine what technology, human resources, and capital requirements the company needs to be successful in the short and long term. Ensure that the current and future owner’s visions are communicated. If both visions aren’t in alignment, discuss what the future for the business may look like. Balancing long-standing business practices with new changes can mean a sustainable and successful business. Begin integrating the future leader into day-to-day business operations before transitioning. Establishing a clear transfer of duties and mapping out a timeline can help with a smooth transfer process.

Get Finances in Order. Preparing business finances in advance of a generational transfer is critical. The current business owner may consider setting up a grantor-retained annuity trust for their successor. An experienced estate planning attorney can help to create this trust, which earns annual income for the beneficiary receiving the funds with minimal or no gift tax liability upon expiration. Family members may also consider transferring their business to the successor through an installment sale, which is a sale of property where at least one payment is received after the tax year in which the sale occurs. Note that an installment sale could mean a tax benefit for the seller because the overall tax liability is spread out over time rather than all at once during the business transfer. Once you decide on the preferred financial path to conduct the transfer, look at the company’s cash flow and other financial projections. List the projected expenses, liabilities and potential taxes owed, and then identify sources of liquidity to pay them.

Work With Financial Partners. If not already in place, look to assemble a team of trusted advisors, including a CPA, attorney, banker, and wealth advisor. This team can work through the financial aspects of any generational business transfer.

Transferring a business is a major family event involving potentially tough conversations and decisions. This can be a complex process. However, with proper planning, it also has the potential to be an opportunity to achieve new growth and elevate long-standing family business goals.

Reference: AZ Big Media (June 8, 2023) “Passing the torch: Considerations for a successful generational business transfer”

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How Much Does Medicare Pay for Nursing Home Stays?