Hurley Elder Care Law Newsletter - August 2017
Having trouble viewing this email? View Online
» Visit website
August 2017   

“I don’t need Medicaid, I have Medicare.” 

Who pays for nursing home care?

There is so much confusion about who pays for nursing home care. The laws and regulations get more complex each year, and many families only have to navigate this issue once in their life; so, the confusion is understandable.  There are, essentially, just four ways to pay for nursing home care:

1. Long-Term Care Insurance - If you are fortunate enough to have this type of coverage, it may go a long way toward paying the cost of the nursing home. Unfortunately, only a small percentage of the population has long-term care insurance, so, most people facing a nursing home stay do not have this coverage. Even if the nursing home resident has long-term care insurance, it may not pay the full cost of the nursing home bill. Many policies only cover $100/day of care costs. Nursing home care can cost around $260/day.

2. Income and Assets - This is the method many people are required to use at first. Quite simply, it means paying for the cost of a nursing home out of your own pocket. Unfortunately, with nursing home bills averaging $260/day, few people can afford a long-term stay in a nursing home.

3. Medicare - This is the national health insurance program primarily for people 65 years of age and older, certain younger disabled people, and people with kidney failure. Medicare provides short-term assistance with nursing home costs if the beneficiary requires short-term rehab or skilled nursing services.

4. Medicaid - This is a federal and state funded and state administered medical benefit program which can pay for the cost of the nursing home if certain asset and income tests are met.

Since the first two methods are self-explanatory, we will focus on Medicare and Medicaid. Let’s start with Medicare. Medicare is the federally funded health insurance program for people age 65 and older as well as individuals deemed to be disabled. In general, if you are enrolled in the traditional Medicare plan, and you’ve had an inpatient hospital stay of at least three days that then led to an admission to a skilled nursing facility (often for rehabilitation or skilled nursing care), Medicare will pay for up to 100 days of your nursing home care per benefit period. If you have a Medicare Advantage Plan, you still have access to nursing home care for rehab, but each plan has different limits on those benefits. If you qualify, Medicare will pay for the full cost of the nursing home stay for the first 20 days; days 21-100 have a co-pay of $164.50/day. Some Medicare supplemental insurance policies (or Medigap polices) cover the co-pays. So, in the best-case scenario, a Medicare beneficiary can get up to 100 days of care in a skilled nursing home paid for by Medicare per benefit period. (Note: Once the Medicare beneficiary has not received a Medicare coverage level of care for 60 consecutive days, the beneficiary may again be eligible for a new benefit period and thus a new set of 100 days of skilled nursing home care.) So, do folks usually get 100 days of nursing home care? In our experience, it usually falls far short of the 100-day maximum. If the nursing home resident will not benefit from therapy or skilled care and just needs to live in a nursing home for the custodial care, Medicare will pay nothing. Even if Medicare does cover the full 100-day period, then what? What happens after those 100 days? The skilled nursing home coverage that Medicare provides is limited to a temporary, short-term benefit. At that point, one of the other methods of paying for nursing home care must be chosen: long-term care insurance, paying the bills with your own assets, or qualifying for Medicaid.

Could Medicaid really be an option for you? There are strict rules about who can qualify for nursing home Medicaid, but it is the largest payer of nursing home care in Georgia. Most nursing home residents in Georgia rely on Medicaid to help pay some of the costs. The state of Georgia has an income cap limit on Medicaid eligibility of $2,205/month, but in reality, you can be eligible for Medicaid if your income is below the private pay rate of the nursing home. So in most cases, a person must make less than $6,175/month in order to qualify for Medicaid.  If your income is above the income cap of $2,205/month, you must use a Miller Trust, or Qualified Income Trust, to qualify for Medicaid.  In addition to the income limits, Georgia also has asset limitations.  The individual applying for Medicaid can have no more than $2,000 in countable assets.

If an older person is receiving skilled care or rehabilitation services in a nursing home that is being paid for by Medicare and if it is unclear if they will be able to return home, that is a good time to meet with an elder law attorney.  The reason for this is that while Medicare is paying the nursing home bill, the spouse or family of the individual in the nursing home will have time to consult with the elder law attorney and consider and implement any Medicaid planning options.  Many families wait to contact an elder law attorney until after Medicare benefits have ended and they have been asked to start paying the private pay rate at the nursing home.  A rate of $260/day is common in the Metro Atlanta area; and after just one week, the nursing home bill can be $1,820.00.  A large nursing home bill can be racking up, making the family feel like they’re in crisis and rushed into making difficult decisions. By consulting with an elder law attorney earlier in the process, this stress can be avoided, better care decisions can be made, mistakes can be avoided, and more money can be saved. To start this process with Hurley Elder Care Law, please call our office at (404) 843-0121.

Family Business We would like to welcome the two newest members to our Hurley Elder Care Law Family. Lillian Morgado (left) is part of our Public Benefits team and Amanda White (right) is part of our Marketing team. Be sure to say “hell0” to Lillian and Amanda when you come across them in the community!  
Upcoming Speaking Events and CEUs

Tuesday, August 22nd-  Join Miles P. Hurley, JD, CELA, for a Complimentary Lunch CEU on “Guardianship: An Overview and Ethical Consideration for Healthcare Professionals” at Ridgeview Institute Monroe

The process of applying for guardianship (or conservatorship) is complex and can be overwhelming to healthcare professionals and families alike – we will review the basics of guardianship and conservatorship. These situations are likely to be unpleasant for the proposed ward as well as the proposed guardian. Such hearings demand families share humiliating and very personal stories, at times publicly shaming one another in front of a judge. What are the ethical implications of suggesting to a family that they pursue this route? We will explore the ethical principles professional social workers/case managers must confront within the guardianship process. In addition, learn what can be done to avoid Guardianship/Conservatorship. Current information on Georgia’s Advance Directive will also be provided. CEUs available: 1 ethic or core hour for social workers (GA NASW); 1 contact hour for case managers (CCMC); 1 contact hour for RNs (TNA). 11:30 AM -12 PM: Registration & Lunch, 12 PM-1 PM  CEU Education, Ridgeview Institute Monroe, Community Room, 709 Breedlove Dr, Monroe, GA 30655. RSVP:

Wednesday, August 23rd- Join Danielle Humphrey, JD, CELA,  for a Complimentary Lunch CEU on "Capacity, Competency, and Ethical Interventions: A Legal Discussion for Healthcare Providers” at Garden Plaza at Lawrenceville

Conflicts of interest and determining decision-making capacity often create complex ethical dilemmas for case managers, social workers, and other practitioners working with older adults. Competing interests of the older adult's family can also make helping individuals make difficult decisions even more challenging. This presentation will provide guidance and tools for assessing areas of concern when clinicians are confronted with ethical dilemmas. The presenter will explain the difference between capacity and competency and provide guidelines for evaluation. Our speaker will also review an ethical decision-making model for practitioners to use when confronted with such dilemmas in clinical practice. CEUs available:  1 ethic or core hour for social workers (GA NASW); 1 contact hour for case managers (CCMC); 1 contact hour for RNs. 11:30 AM -12:00 PM Registration and Lunch, 12:00 PM-1:00 PM  CEU Education, Garden Plaza at Lawrenceville, 230 Collins Industrial Way, Lawrenceville, GA 30043. RSVP:

Tuesday, August 29th- Join Miles Hurley, JD, CELA, and Deke Cateau, Chief Operating Officer at A.G. Rhodes for a Complimentary Discussion on “The Dementia Maze: Understanding Your Options and Cost of Care” at A.G. Rhodes Health & Rehab in Marietta

Discussion will include information on dementia and the important steps you can take now to protect your assets, your family and your wishes. The earlier you plan, the more options you will have available. This event is open to the public. 5:30 PM- 7:00 PM Refreshments and Discussion, A.G. Rhodes Health & Rehab, 900 Wylie Rd. SE, Marietta, GA 30067. RSVP: or 404-432-0121

Tuesday, September 12th- Join Danielle Humphrey, JD, CELA,  for a Complimentary Dinner CEU on "Planning for the Expected: Decisions, Documents and Death”  at The Waterford at Hidden Lake

Death is unavoidable, yet most Americans are woefully ill prepared for this eventuality; planning for the expected means taking control. Attorney Humphrey will provide guidelines to begin essential conversations about advanced planning and the benefits of taking charge of the inevitable. This presentation offers a welcome road map for healthcare professionals supporting patients and their families facing the end of life. Key discussion points include: the impact of dying without a will, the benefits of a trust, detailed guidelines regarding what to do when someone dies as well as an overview of the probate process. CEUs available:  1 core hour for social workers; 1 contact hour for case managers; 1 contact hour for RNs. 5:30 PM- 6:00 PM Registration & Dinner, 6:00 PM-7:00 PM CEU Education, The Waterford at Hidden Lake, 3100 Hidden Valley Drive, Canton, GA 30114. RSVP: 

Tuesday, September 19th- Join Danielle Humphrey, JD, CELA, for a Complimentary Dinner CEU on "Planning for the Unexpected: Losing Cognitive and Functional Capacity” at Park Springs Health Services- Pebblebrook

Planning for the unexpected means recognizing the potential for a loss in functional and cognitive capacity. A severe stroke, fall or dementia diagnosis creates a family-wide sense of vulnerability.  This continuing education presentation will help healthcare professionals learn to identify with confidence where individuals may be on the care continuum and understand the resources available at each stage.  Key discussion points include: a thorough review of functional and cognitive capacity, an overview of the specific stages of the long-term care continuum (with supporting case studies) and a review of practical methods families may utilize to prepare for scenarios encountered as loved ones age. CEUs available:  1 core hour for social workers; 1 contact hour for case managers; 1 contact hour for RNs. 5:00 PM-5:30 PM Registration & Dinner, 5:30 PM-6:30 PM CEU Education, Park Springs Health Services, Pebblebrook Skilled Nursing and Memory Care Center, 5610 New Bermuda Road, Stone Mountain, GA 30087. RSVP:

Tuesday, September 26th- Join Miles P. Hurley, JD, CELA, for a Complimentary CEU on “The Dementia Maze: Understanding the Options and Cost of Care” at The Phoenix at Dunwoody

Every 67 seconds someone in the U.S. develops Alzheimer’s, and one in three seniors will die with Alzheimer’s or another dementia. The purpose of this activity is to review the basics of Alzheimer’s disease and then analyze the financial impact of the disease to families and employers as well as those affected by it. Knowing the options available and planning for the unexpected loss in functional and cognitive capacity is the best way for healthcare professionals to advise their patients and families. The earlier you plan; the more options are available. Dementia is hard enough when there is a plan in place; dementia with no plan will leave families exhausted, stressed and broke. CEUs available: 1 core hour for social workers; 1 contact hour for case managers; 1 contact hour for RNs. 5:00 PM-5:30 PM Registration and Snacks, 5:30 PM-6:30 PM- CEU Education, The Phoenix at Dunwoody 4484 N Shallowford Road, Dunwoody, GA 30338. RSVP:

Thursday, September 27th- Join Michelle Allen, LCSW, for Complimentary CEU on “Successful Nursing Home Placements” at Hurley Elder Care Law

The decision to transfer a family member to a nursing home can be a difficult one. The many emotions arising from such a decision may be impacted further by a complex placement process. It is the family’s responsibility to explore facilities and to make decisions about which facilities can best meet the patient’s financial, physical, social needs, but health care providers also play a crucial role. Case managers and social workers must understand how to complete the DMA-6 and Level 1, how to navigate the options, and how to advise families on paying for nursing home care. Please join us to learn what you need to accomplish Successful Nursing Home Placements. CEUs available:  1 core hour for social; 1 contact hour for case managers. 4:00 PM-4:30 PM Registration and Snacks, 4:30 PM-5:30 PM CEU Education, Hurley Elder Care Law, 100 Galleria Parkway, Suite 650, Atlanta GA 30339. RSVP:

For more details and a complete list of upcoming events, please visit Hurley Elder Care Law Community Education.
Recent BlogsFinancial Victimization of Elders- Learn how to prevent elder fraud.

Tips for Communication- Read about ideas on communicating with the elder.

Caregiver Tips- These ideas can help you cope with caregiver stress.

They Just Won’t Quit- Tips to avoid telemarketing calls.

Elder Care Resources
Beat the Heat- Learn about risks to seniors during the hottest months of the year.

Medicaid Rules for Individuals- Take a closer look at Medicaid’s income rules.

Toolkit for Dementia Diagnosis- Online resources for  initial detection.

 National Park Senior Passes- Annual pass price set to increase on August 28th.

Miles P. Hurley, JD, CELA  Miles P. Hurley founded Hurley Elder Care Law in 2006 to provide legal assistance to the elderly population on issues relating to aging including retaining independence, quality of life and financial security. Mr. Hurley is one of eleven attorneys in the state of Georgia to receive the Elder Law Attorney Certification, and one of approximately 400 nationwide. 
Hurley Elder Care Law is dedicated to the process of long-term care and estate planning. 
Call us today for a free phone consultation with a client coordinator at (404) 843-0121.

Like us on Facebook!
Like us on Facebook to stay informed about our events and important elder law information.
Follow us on Twitter!
Follow us on Twitter, to stay up to date on important elder law information and Hurley Elder Care Law news.
Connect on LinkedIn!
Connect with us on LinkedIn for updates on our upcoming CEU presentations and helpful elder law information. 
Hurley Elder Care Law
100 Galleria Pkwy, Suite 650
Atlanta, GA 30339

Satellite Offices
2011 Commerce Dr. Suite 100, Peachtree City, GA 30269   
225 Creekstone Ridge, Woodstock, GA 30188       
2180 Satellite Blvd, Suite 400, Duluth, GA 30097

Share on Facebook, Twitter
This newsletter was sent to
UnsubscribeUpdate Email Address

Direct Mail for Mac This email is powered by Direct Mail for Mac. Learn MoreReport Spam