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Will Managed Care Help California Seniors?

California is planning to combine the services offered by Medicare and Medi-Cal, California’s version of the federal Medicaid program, streamlining the administrative aspects of both into one body. The hope is that a managed health care system will eliminate the confusion, mistakes and crippling amount of overhead that has been the hallmark of juggling both Medicare and Medi-Cal.

There are more than one million elderly people in the state who have been working with this dual system. Gov. Jerry Brown has said that he estimates at least 500 million dollars will be saved by combing the two. The concern, of course, is that combining the two systems may simply be untenable. This new, managed care system will have to oversee the federally funded Medicare, plus the state-federal Medi-Cal, as well as social services.

The new system will be put into place after October 1 of this year as part of a three-year experiment in the Orange County area. For someone who is sick, dealing with three separate administrative entities, with multiple insurance plans and services can be overwhelming. Hopefully this new system will make managing care as painless as possible.

If you have concerns about your long-term care or managed care plans, please do not hesitate to contact the attorneys at Gilfix & La Poll.

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Nursing Homes: When You Are Concerned About The Quality of Care

Nursing home abuse can be an emotionally loaded subject. Having to relinquish some control of the care and treatment of our elderly loved ones to a facility can make people feel guilty, anxious and upset. But few spouses, adult children or even extended family households are equipped to handle the activities of daily living support, much less any medical needs, that someone who is elderly and/or medical frail may require. That is why nursing home and other senior care facilities are so prevalent in the U.S. – we need them.

Unfortunately, not all facilities are able to provide the care that patients require, either due to staffing issues, budget cuts, poor management, or a host of other issues. Nursing home abuse can be as overt as a patient who is physically or emotionally assaulted, or as subtle as when someone is neglected enough that they develop bedsores or dehydration.

Some red flags which may indicate further investigation is warranted:

  • Has the patient developed bedsores?
  • Does the patient have unexplained bruises?
  • Has the patient fallen in the facility one or more times?
  • Has the patient's behavior changed? Has he or she suddenly become socially withdrawn, fearful or uncommunicative?
  • Does the patient show signs of poor hygiene?
  • Does the patient seem uncomfortable around or fearful of a staff member?
  • Are you able to visit alone with the patient?
  • Does the patient have any personal items missing?

Many clients are concerned about reporting suspected abuse; they want to believe it does not happen, or that they are overreacting. But the general rule is that if you suspect something, say something. Let the authorities decide if your concerns have merit. It is not your job to know for certain. It is your job to speak up as an attentive advocate for your loved one.

If you suspect nursing home abuse, Gilfix & La Poll can help.

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Worried About the Cost of Nursing Home Care? You Should Be

The latest numbers show why so many people are worried about being able to afford nursing home care: approximately one out of two women and one out of four men will need nursing home care at some point in their later years. Nursing home care is expensive, and Medicare will not cover long-term care costs. Most people end up depleting their life savings within the first twelve months of what ends up being a prolonged stay.

A long-term care insurance plan that was included in the 2010 Affordable Care Act, but it has been abandoned because it was fiscally unworkable. Congress has launched a study commission to try to develop solutions to the overwhelming need for long-term care support. That support is sorely needed: the average cost of a private room in a nursing home here in California is $91,250 per year, and the national rate is $77,745 per year. The Department of Health and Human Services estimates that 70 percent of people over the age of 65 will need some type of long-term care; more than 40 percent will need long-term nursing home care. And few people have prepared for that cost. Life savings are depleted, or the cost is placed on loved ones who must choose between their own financial security and giving their parent the best care possible.

Critical to this area of planning is Medi-Cal. With careful, professional planning, estates can be protected white nursing home residents qualify for Medi-Cal, which can pay all or most of the cost of such care.

Work with the elder law and estate planning attorneys at Gilfix & La Poll to secure your future long-term needs.

Michael Gilfix is an estate planning attorney in Palo Alto California and is one of the pioneers of elder law. To learn more, visit Gilfix & La Poll Associates LLP at

How to Protect Your House Before and After Moving to an Assisted Living Facility or Nursing Home

Many people worry that they will have to lose their home and other assets to qualify for Medicaid, known as Medi-Cal in California.

It is not standard procedure for someone to be required to sell their residence in order to qualify for Medi-Cal coverage when they need nursing home care, because it is an exempt asset, its value is not counted in determining eligibility, but it's possible that the state will file a claim against that individual's home after they die.

If an individual uses Medi-Cal to finance nursing home care, the state will likely require that the individual's estate pay back what it can to cover these costs. "Estate recovery" happens when Medi-Cal goes after whatever assets remain in the person’s estate. In most cases that means a personal residence. That is why individuals who are considering entering a nursing home are strongly advised to work with an elder law or estate planning attorney before making any decisions, in order to protect their home and assets. The residence can be protected, particularly in California.

The federal Deficit Reduction Act of 2005 puts a limit on the value of a residence for a single person if it is to be considered exempt. Exempt status can be lost if the equity of the home is less than $500,000 (or $750,000, depending on the state). Regardless of the state, the resident is allowed to hold onto the home without an equity limit if their spouse or some other dependent relative resides there. California is yet to implement the DRA, so there is no limitation on the value of an exempt residence in California.

Some people choose to transfer their home to an adult child or other family member, in an attempt to protect it from Medicaid. Many states impose a Medicaid penalty period; they become ineligible for Medicaid for a set period of time. However, there are times when transferring a home is legal. Again, this is when consulting an elder law or estate attorney is in everyone's best interest. A home may be transferred without a transfer penalty to a spouse or to a child under the age of 21 or an adult child who has a disability, or to a caretaking child, or to a sibling who has resided in the home for a set amount of time prior to the individual's move to a nursing home or other institution and who hold s equity in the home. A home may also be transferred into a trust for the sole benefit of a disabled individual who is below the age 65. Each of these situations has restrictions and caveats, and should be run past an attorney.

Even more can be done in California. A residence can be transferred to any one or to any trust without a penalty period for Medi-Cal eligibility. This is largely because California has implemented neither the DRA nor other relevant provisions of federal Medicaid law.

Simply stated, the residence can be completely protected in California with property tax sensitive planning.

For information about how to protect your estate and assets, contact an elder law or estate planning attorney at Gilfix & La Poll.

Michael Gilfix is an estate planning attorney in Palo Alto California and is one of the pioneers of elder law. To learn more, visit Gilfix & La Poll Associates LLP at