Life Care Planning

By Maureen Rulison
Caregiver Support and Resources, LLC

There’s so much to consider in life care planning. You’re worried about health and financial stability for your loved one who requires care (and everyone else involved). You must also factor family relationships and personal realities in this puzzle with many moving parts. But despite our best efforts to predict the future, unexpected emergencies can completely derail even a great life care plan.

From sudden illnesses to financial struggles – and even natural disasters – it’s essential to be prepared for the unexpected to ensure that your loved one’s life care plan remains on track, or can at least adapt to changing realities.

What Could Possibly Go Wrong? Here are Some Common Life Care Plan Emergencies

That’s the million-dollar question: what could possibly go wrong? Unfortunately, we’ve seen too many care partner teams assume, with a solid life care plan in place, that everything is going to be fine. But a plan with no flexibility can make even minor emergencies worse. 

Here are some realities to consider:

1. Family Emergencies

Family emergencies – like the unexpected death of a supporting care partner or a divorce – can place significant strain on your life care plan. Essentially, you can never guarantee who will be there to help tomorrow. The neighbor who frequently checks on your mother may become ill herself. A daughter-in-law may quickly become an ex-daughter-in-law. 

The list goes on.

Events like these can carry emotional stress, financial strain, and loss of support you previously counted upon from family members and/or close friends. Couple that with the uncertainty of adjusting roles in the life care plan, and already heart-wrenching scenarios can become fatal flaws.  

2. Sudden Illnesses

Caregivers can have health issues, too. We’re all human. While your loved one is intended to be the focus of care, it’s easy to see how poor health within the team can throw a wrench in an otherwise well-oiled machine. 

Sudden illnesses can be both physically and financially debilitating. They can result in extended hospital stays, rehabilitation and lost wages from time off work. So caregiver self-care is imperative. It’s also vital that care partners have some sort of adequate health insurance coverage. 

Your care – before you can care for someone else – won’t accomplish much without your own health and stability.

3. Financial Hardship 

Finances are one of Americans’ greatest stressors. Nearly two-thirds of us live paycheck-to-paycheck. Yet, the responsibility to care for loved ones doesn’t care how much (or little) we make.

Job loss can pull the rug out from under anyone. Without a slush fund, paying bills and maintaining a lifestyle – while still caring for your loved one – would be nearly impossible. A network of professional contacts that can assist you in finding a new job is incredibly valuable.

Market fluctuations also can significantly impact financial stability, particularly if you have investments that are heavily tied to the stock market or property. It’s easy to get under water when market factors beyond your control send prices soaring and value plummeting. Diversify your investments to prepare for market volatility, so dips and recessions can’t cause quite so much damage.

4. Natural Disasters

People tend to leave these potentials for last in a life care plan. But a hurricane, forest fire, tornado, earthquake, 500-year flood or some other cataclysm is always waiting on the other side of tomorrow.

My life partner/care partner, Brian (who lives with dementia) and I live in Clearwater, FL. There seems to always be a tropical storm, at the very least, heading our direction during hurricane season. Just last year, Hurricane Ian narrowly missed our area, but forced our evacuation and caused a series of nightmares that could’ve derailed our life care plan indefinitely.

The physical damage was the least of our concerns. Stress and changing environments with dementia can certainly speed up the disease’s progression. Not to mention the travel issues that would’ve left us trapped and without access to emergency services for days or weeks. 

So it’s important to have a disaster preparedness plan including contingencies for evacuation, the location of shelters, and close care partners who could provide assistance when emergency services can’t reach you.

Are You Prepared for Emergencies in Your Life Care Plan?

To prepare for family emergencies, it’s important to build and nurture the care partner team. Your team is your support network, including close friends, family members and professional support services that are prepared to help when times get rough. If possible, work toward having a solid emergency fund in place, as well, so you’re not forced to choose between paying bills vs. necessary medical treatments. 

If you need help, Caregiver Support and Resources, LLC has over 25 years of experience  with all aspects of life care planning, including care partner team-building, Medicaid planning and board-certified patient advocacy. We’re happy to provide referrals and guide the process in a caring and compassionate way.

By Maureen Rulison
Caregiver Support and Resources, LLC

Life care planning can be an uncertain process. And it’s tough even when you’re working with things you do know – like if your father has a living will or that eventually your aunt’s cancer treatments will no longer be effective. But what of the things you don’t know? Are you prepared to factor the unexpected?

As my Brian’s life partner/care partner along his path with dementia, I’ve even had difficulty preparing for the unknown (and that’s as a professional life care planner and Board-certified patient advocate who’s been doing this work for nearly 30 years). We’ve encountered numerous scenarios beyond our control that required flexibility and adaptability – not only from us but from everyone on our care partner team. 

Of course, you always want to ensure your loved one’s well-being and happiness, no matter what the future holds. Because it’s not always good health, sunshine and rainbows. So it’s essential to plan for rough seas beyond the horizon when building a life care plan. 

Some Great Reasons to Account for the Unexpected in Your Life Care Plan

You can’t let your life care plan get too rigid. Essentially, this living, breathing document can’t be too sure of itself. 

• Will your older brother continue to age in good health? Or will a sudden and massive stroke leave him unable to speak the remainder of his days? 
• Will your assets be safe for the next 25 years? Or will the stock market crash again next week? 
• Will a trusted care partner be able to help your mother cook and clean? Or will he move across the country for work next year?

And these are just some of the potential questions and scenarios. One of the most significant advantages of having a life care plan is that it provides peace of mind for both you and your loved ones – when it works well. When the unexpected happens, it can be an emotional and challenging time.

But identifying risks and planning accordingly to have contingencies can ease the stress and uncertainty. Here are a few of the benefits of thinking ahead:

1. Protect Your Finances

Money can’t buy happiness, but it sure makes things easier. Unexpected events can put the worst possible strain on your family’s finances. If a loved one falls ill and needs medical treatment, the costs can quickly add up. In a poor economy, even the most comfortable families may fall upon hard times due to failing investments, plummeting property values or and/or unemployment. 

But by recognizing these possibilities, you can work to set aside that rainy-day fund when times are good to cover any unanticipated expenses if times get bad.

2. Ensure Continuity of Care

If something unexpected occurs, will your loved one’s care continue without interruption? In an emergency, who will be there to help? That’s something Brian and I experienced two winters ago when I became deathly ill with pneumonia, and others on the care partner team were not available due to work, travel and other responsibilities to address the emergency. It was the perfect storm. 

If a primary care partner becomes unavailable, you MUST have backup arrangements to ensure that your loved one’s needs are still met. And then have backups for those backups. And then fire drill that plan to ensure continuity of care actually works when disaster impacts your life care planning.

3. Avoid Confusion and Disputes

Unexpected events can cause confusion and argument, particularly if you do not have a plan in place. If a loved one falls ill and requires medical treatment, there may be conflicting opinions on the best course of action. Does your loved one see a certain doctor or avoid a certain medication/treatment? Did they spell out certain financial or legal wishes that may be necessary in an emergency – years or even decades before they should’ve been?

Unexpected realities don’t have to be unexpected. You can avoid such confusion and indecisiveness by planning so everyone is on the same page when it comes to your loved one’s care. Well-communicated planning ensures your loved one’s wishes, well-being and happiness are taken care of, no matter what the future holds. 

4. Have Peace of Mind

A step further, life care planning with some foresight provides peace of mind. Even if you’re not a Type A person, being able to rest easy is worth its weight in gold. Just knowing helps – even if your life care planning works to know what can’t yet be known. 

Of course, unanticipated events cause stress, anxiety and uncertainty. Your life care plan can address issues that aren’t even on your radar today to ease the burden tomorrow. 

5. Adapt to Changing Needs

As your loved one(s) and the care partner team move through life, there will inevitably be proverbial fires to put out. But not all of them are five-alarm blazes. 

Life is unpredictable, and a life care plan that factors the unexpected offers the flexibility to accommodate changes as they occur. Your loved one’s health won’t follow a playbook – good or bad. So your life care planning should be easily revised to accommodate changing needs. A new diet may be required, or a loved one may no longer be available to stop by for brief “coffee visits.” That’s fine. Let’s plan around that!

How Can We Help with Your Life Care Planning Needs?

I work with care partner teams every day to guide the life care planning process and coordinate resources needed for each step of the care journey. These plans may be specific, but they also require flexibility.

We all face important decisions – in good health and bad, expected or unexpected. There are many moving parts to planning care for quality of life and financial protection. You need an expert life care planner and Patient Advocate who knows each required step for your loved one’s well-being today and tomorrow.

Contact me at maureen@caregiversupportandresources.com to get started today.

By Maureen Rulison
Caregiver Support and Resources, LLC

We prefer it, even if so much of it is centered around language alone. What is person-centered care? It’s a philosophy that empowers the individual at the center of care. Sometimes individuals, as couples later in life often prefer to trek the journey together. 

How is it so empowering? We’ll give some examples:

• My life partner/care partner, Brian, lives with Alzheimer’s and vascular dementia. He hates being labeled as a “sufferer” of dementia. Negative language itself places him at a disadvantage. He’s not a “sufferer.” He simply lives with the disease. 
• A wonderful woman living in an advanced-care facility complains about medication side effects. The doctor “in charge” of her care won’t listen and says, “It’s best for your condition.” Is it, though? With person-centered care, the woman directs her care, and it’s the doctor’s responsibility to use their expertise to find better options.
• A married couple agrees it’s time to research assisted-living homes. One spouse is becoming quite sick. The other is in great health. But they both wish to go in together. Their children disagree. Whose decision is right? With person-centered care, their choice should be honored because they believe being together improves their lives and care outcomes.

Person-Centered Care & Language Empowers the Individual

Now let’s break it down a bit further. It’s also referred to as person-focused or person-directed care. Tomato/to-mah-to – they accomplish the same thing: empowerment over care decisions and everyone’s God-given right to live and die with dignity.

Here’s how.

A Voice & Choice in Care Decisions

Once upon a time, in a galaxy not so far away, medical professionals called all the shots. They analyzed, made a decision and ordered it done. Now, of course, there are still medical professionals who operate this way, but the overwhelming trend toward person-centered care is rendering those methods obsolete. 

Yes, doctors, nurses and other pros in the continuum of care have years of education and experience that we must consider and respect. But who knows their body and mind better than the person living in it? Who knows how it feels? Who knows how it reacts? That’s right: you and/or the loved ones entrusted with care decisions. Care isn’t being given from a higher power. It’s being coordinated by equal voices. (Helpful hint: With some great life-care planning, person-centered care allows people to speak for themselves even after they can no longer speak.)

Words Matter

Person-focused language is compassionate. Our loved ones deserve that compassion – whether they’re aging in good health or bad. It’s fair. It’s balanced.

Terms like “caregiver” aren’t as fair and balanced as the person-focused term “care partner.” “Caregiver” connotes a superior relationship between a person who is “more capable” and one who “can’t care for themselves.” While “care partner” connotes an equal relationship – a “partnership in care.”

The list goes on:

• “Resident” – someone who lives in a place vs. “Patient” – someone dependent on care.
• “At risk for falls” – someone who may fall vs. “Falls risk” – a demeaning label.
• “Prefers not to” – expresses personal will vs. “Non-compliant” – a label of insubordination.
• “Facility” – an institutional setting vs. “home” – a place of comfort and healing. 

Person-centered language removes labels and restores power where it should be: with the individual.

Building Your Circle of Support

What is person-centered care if not a way to mobilize the people, programs and professionals that’ll make life easier? The individual has the power. They know best. They know who knows them best and will provide the most effective and fulfilling life care. 

Your loved one sits at the center of the care-partner circle. They receive care, of course, but with person-focused care, they have the most important job: directing care. Everyone else surrounding them – from siblings and spouses to doctors and faith leaders – play equally vital roles providing love, support, guidance and medical treatment.

Reversing the Stigma

Along the same lines as person-focused language, this care philosophy does a fantastic job changing negative perceptions about aging and illness. The stigma, if you will.

A lot of this stigma can be attributed to culture and media. It’s hard to feel good about oneself when the global narrative glorifies youth, beauty and fitness at every turn. Thus, recognizing age and illness as natural human processes becomes more difficult. Who wants to be seen as “ugly” and “frail”? But getting older isn’t ugly, and illnesses we don’t choose aren’t weaknesses. Person-centered care, in turn, recognizes and honors our loved ones living through the reality life throws at everyone eventually.     

Different Strokes for Different Folks

Sometimes seeking alternative approaches and perspectives – thinking outside the box – yields better results. You’re correct in requiring other options and opinions. Under person-centered care, health professionals are obligated to use their expertise to provide those alternatives themselves (or at least indicate the right direction).

This empowers your loved one during doctor visits and other wellness consultations. Years ago, top-down approaches and one-size-fits-all treatments relegated care recipients to obedience. “Follow the doctor’s orders” was the common phrase. But no one, professional or not, should dictate care beyond the individual themselves.

So What is Person-Centered Care? It’s a Gateway to Better Care … On Your Terms

People aren’t defined by their care needs. Those who provide care aren’t in charge. The person-centered care philosophy – in both words and actions – restores power to the individual. Our good friends at the Pioneer Network and Eden Alternative have led these culture-change efforts for decades.

And here at Caregiver Support and Resources, LLC, we explore all paths to person-centered care through Board-certified Patient Advocacy, life-care planning and more. We’re happy to guide the process in a caring and compassionate way. 

Email me at maureen@caregiversupportandresources to discuss your needs – because we value you as an individual.

By Maureen Rulison
Caregiver Support and Resources, LLC

Your parents (or other loved ones) are getting older. Most of us at this stage – watching them enter their “golden years” while getting “up there” ourselves – try to assess “the damage” to see when it’s appropriate to make BIG DECISIONS. Can life-care planning wait a few more years? 

While otherwise healthy, they’re showing some signs of aging. You may say to yourself:

• “Why would I upset them now with talk of end-of-life care?”
• “They’re still working. Shouldn’t we at least get to retirement first before the tough discussions?”
• “I assume their finances are in order.”
• Or worse, “Someone else should have this talk with them.”

They’re common thoughts. Understandable even. But they’re also misperceptions, rooted in assumptions, uncertainty and the fear of upsetting others. At best, they’re also wishful thinking – a very human tendency to hope for the best and avoid considering the worst.    

So how long should you wait before starting the life-care planning process? If possible, the time is now! Don’t be among the two-thirds of American adults without a formal care plan. 

Can Life-Care Planning Wait? No. Here’s Why

To truly have a LIFE WORTH LIVING, life-care planning must be done ASAP so you and your loved one can focus on the real joys of life. Get it out of the way early, while everyone’s thinking clearly, so everyone can move on and enjoy the remaining years without worry. Because here are some realities:

• Years pass quickly – with or without action
• Emotions get stronger closer to “the end”
• Decision-making only gets harder
• Legal & financial matters can take years to resolve

We’ve said before that a life-care plan usually has about 9 parts. But let’s break it down even more simply into 3 easy steps.

1. Honor Your Loved One’s Wishes

A life-care plan must be personalized. It’s your Mom’s plan, or your parents’ joint plan, or your cousin’s or aunt’s. No one else’s. While your parent or other aging loved one is still healthy, it’s essential to learn their preferences directly from them. (My life partner/care partner, Brian, who lives with dementia, made this video to his future care partners while he was still cognizant enough to advocate for his needs and wants.) 

This gives the individual the opportunity to tell their own story while they still have the enthusiasm and mental capacity for it. Have them write it down or do a quick-and-easy video like Brian’s, or even say it into a recorder. Whatever works.

2. Build the Circle of Support

In our circle of support, it’s called the care-partner team. We prefer the person-centered term “care partner” to “caregiver” because even language requires a level playing field. “Caregiver” implies power over decision-making, while “care partner” implies an equal voice.

So let’s build the care-partner team. Your parent/aging loved one can choose those best suited to do individual jobs. It’s their choice, and it’s best to figure this part out early so the individuals involved can prepare. It’s in everyone’s best interest to have these conversations without grief or intense emotions. 

3. Build the Care-Delivery Mechanism

With the team in place and the loved one’s wishes factored, now comes a series of vital questions about care delivery: 

• How will care be delivered
• Who will deliver it?
• Where will it be delivered?
• How will it be paid for?
• What will happen in “the end”?

Determining all this early allows the team to have everything in place – from moving to assisted living to involving hospice to preparing financially and legally. Perhaps living happily and healthily at home is possible. Many times, it isn’t. Sometimes key members of the care-partner team can follow through on care promises. Sometimes their circumstances change. So it’s important to make the life-care plan a working document that’s flexible to change.

Can Life-Care Planning Wait? Not If You Want the Process To Run Smoothly

Even Type-A planners couldn’t reasonably be expected to work on a life-care plan while dealing with the emotional toll of an aging loved one. And eventually the aging individual may no longer participate meaningfully in the planning process. It benefits all parties to start having these conversations as soon as possible.

Caregiver Support and Resources, LLC helps the life-care planning process with a guiding and caring hand. Schedule your free consultation with me today. We want the same outcome as you: a LIFE WORTH LIVING for everyone involved.

By Maureen Rulison
Caregiver Support and Resources

Reflecting can be a good thing. But when it comes to the Long-Term Care Medicaid and the 5-year lookback period examining financial eligibility, it’s easy to feel overwhelmed. 

Many of us approaching the twilight of life intend on distributing our assets to loved ones anyways. But the government feels that if those assets are present within 5 years of needing to apply for Long-Term Care Medicaid, they’re fair game to cover the ASTRONOMICAL costs of advanced care.

“What the heck is a lookback period? How is that fair?” you may ask yourself. But it’s just the nature of the beast. A lot of paperwork and lots of red tape are expected for Medicaid, as with any government program. The laws governing it are difficult to comprehend. So we’re here to help.

Medicaid ensures you (and your spouse, if applicable) have not within the last 5 years artificially deflated your financials to achieve eligibility. But there are exceptions! Certain things like meaningful expenditures, gifts, exchanges and transactions can occur within the 5-year lookback period.

Medicaid 5-Year Lookback Exceptions to Keep in Mind in 2023

As you know, your story is told via a paper trail. It’s the government’s due diligence in allowing eligibility for Long-Term Care Medicaid. Simply put, you can’t have significant income and assets — or the state will declare you have the resources to pay for care yourself. 

But Medicaid does understand aging parents, grandparents and other loved ones would distribute wealth and assets in their older years that can’t be used in death. So the exceptions (loopholes, you might say) are there for sound legal and ethical reasons. Experienced estate planning and life-care planning professionals will know to factor these realities. 

1. Home Transfer

Equity in a home is one of the most common gifts to close family late in life and bequests after death. But if you’re planning on gifting a primary residence while still alive, be careful to do so beyond Medicaid 5-year lookback parameters. You may either place the equity in a trust at least 5 years before applying for Long-Term Care Medicaid to be distributed after your death, or you may transfer the property to the following individuals under certain conditions: 

• A legal spouse
• Children under 21 years old
• A blind and/or permanently disabled adult child
• A sibling of the homeowner who has resided in the home for at least a year before the Medicaid applicant transitioned to a long-term care facility
• An adult child of the applicant who has lived in the home for at least two years as a caregiver/care partner before the Medicaid applicant transitioned to a long-term care facility. (The provided care stipulation must be reasonably proven that the adult child providing care delayed the applicant’s need for formal long-term care.)

Of course, Medicaid would require proof of all these familial statuses and other variables to allow eligibility.

2. Married Couples with One Spouse Applying

Quite often, only one spouse applies for Medicaid. While one spouse remains healthy enough to live without assistance, well, the other one sometimes isn’t so fortunate. They must prepare to cover costs for a range of advanced care options – from extra home-care services and respite care to full-fledged nursing home placement. Most people need Medicaid to make that happen.

The Community Spouse Resource Allowance (CSRA) allows the non-applicant spouse to retain much of the couple’s jointly owned assets during the 5-year lookback period while the other still remains eligible.

Here in Florida, there is no penalty for interspousal asset transfers. The CSRA allows the non-applicant (known as a “community spouse”) to keep up to $148,620, while the applicant spouse may keep only $2,000. The thinking, easily enough, is that allowing such asset transfers (including non-residential property, stock portfolios and other investments, and cash savings) to a spouse will protect the applicant’s spouse and other dependent loved ones from having too little to cover living expenses.  

So let’s break down some hypotheticals (updated for 2023):

• If the couple together has $210,000 in net assets, the non-applicant spouse can keep $148,620 and the applicant may retain $2,000. The remaining $59,380 must be spent down or distributed within the rules.
• If the applicant spouse has $250,000 in cash savings alone, (s)he can transfer only $148,620 to the non-applicant and retain $2,000 within the 5-year lookback. 
• If the couple has just $78,000 in net assets, the non-applicant spouse may retain that entire sum.

After these determinations, the remainder of assets during the 5-year period may be used for long-term care costs – regardless of where the care occurs or who administers it.

3. Assets Distributed to Minor Children

Long-Term Care Medicaid applicants may have a minor child or children (under 21 years old), or those who live with any documented disabilities. These children would be eligible to receive asset transfers of any scale  to benefit their own well-being during the 5-year lookback period. 

Life-care planners and legal advisors often recommend establishing trusts to temporarily transfer ownership of funds and assets until the beneficiaries reach adulthood.

These Exceptions to the Medicaid 5-Year Lookback During Your Life-Care Planning

We always advise planning early to ethically and responsibly spend down/distribute assets and property. The best course of action is to have all financial planning and legal issues sorted out well before the lookback, if possible. The exceptions to this important eligibility rule do, however, account for unexpected illnesses and variables that should allow for transactions at any time. 

Professional to help to build a solid plan is recommended, and that is why we are here. Caregiver Support & Resources, LLC works with elder-law attorneys, and we can legally and ethically protect people’s assets to help them qualify for Medicaid and VA attendance. If you need assistance, contact me at maureen@caregiversupportandresources.com.

(Editor’s Note: Caregiver Support and Resources, LLC is not a law office. Maureen Rulison is not an attorney. The information contained in this blog is not to be construed as legal counsel or advice or substituted as such in any U.S. state, territory, locale or foreign state where it can be accessed. Rather, this blog is meant only to educate elders, care partners and families as to legal processes around life care planning.) 

By Maureen Rulison
Caregiver Support and Resources 

Long-Term Care Medicaid eligibility in Florida – or rather the financial figures determining eligibility – changes slightly each year. 

When qualifying for Medicaid, individuals and married couples alike must show the government they don’t have enough money, property and other assets that could otherwise be used to pay for advanced care. In the eyes of the government, those assets SHOULD cover costs, but people have fiduciary responsibilities to their families – meaning they wish to protect those assets. 

So the federal program (operated through each state) allows some provisions. Married couples with one healthy spouse not currently requiring coverage can still qualify for Medicaid under certain income and asset thresholds. Here’s where the Community Spouse Resource Allowance (CSRA) comes in, permitting the non-applicant spouse to retain enough resources to live comfortably.

Let’s Understand 2023 Florida Medicaid Eligibility Rules for Spouses

The terms used for Medicaid are downright confusing. What is a “community spouse”? It’s the non-applicant spouse who is healthy and remains at home – in the “community.” The term “institutionalized spouse” means the spouse — the applicant — may never be “institutionalized” at all and may, in fact, receive benefits covering both home and community care options. “Resources” are assets.

Medicaid helps low-income individuals and families pay the outrageously high costs of long-term care. Here in Florida, even a semi-private nursing home room can cost more than $8,600 PER MONTH! Medicaid eligibility tests like these ensure that people with sufficient assets and/or income do not artificially lower their net worth to qualify as low-income. 

Although income and assets exceeding limits must be used or distributed legally and ethically, Medicaid in most states allows families to keep “resources” for living expenses. The Community Spouse Resource Allowance is one of those measures.

How Does the CSRA Work?

Medicaid, which serves individuals and families with little income and assets, ensures people meet qualifications through financial/asset disclosures and a detailed 5-year lookback analysis. But they won’t leave a non-applicant spouse (“community spouse”) without money to live independently.

The Community Spouse Resource Allowance allows the non-applicant to keep assets up to a certain amount. Florida is a 100% state for which that maximum figure in 2023 is $148,620. The applicant spouse could keep $2,000. 

Ultimately, individual states determine maximum and minimum income and asset limits for Medicaid eligibility up to the states’ discretion. In 100% states like ours, non-applicant spouses are entitled to all of their joint assets up to the maximum resource allowance.

Some examples specific to Florida: 

• The married couple has $350,000 in assets. The non-applicant (“community spouse”) may retain $148,620 of that sum. The applicant may retain $2,000, leaving $199,380 that must be spent down or given to family, friends and/or trustees.
• The married couple has $129,000 in assets. The non-applicant may retain the entirety of that sum, as it is under Florida’s maximum CSRA.

Spending down or distributing any remaining assets, if necessary, MUST be done before the Medicaid 5-year lookback to avoid an ineligibility penalty period.

Exceptions & Exemptions

Of course, there are other exceptions. Countable assets include cash, stocks, bonds, investments, credit union, savings, and checking accounts, and non-residential real estate. Medicaid considers some assets exempt (non-countable), including among others a primary residence, home furnishings and appliances, an automobile, irrevocable burial trusts, and IRAs in payout status. For the home exemption, however, the Medicaid applicant must live in it or have intent to return, and in 2022, have a home equity interest no greater than $636,000.

Caregiver Support and Resources, LLC works with elder attorneys and clients to examine these realities and determine the most fiscally responsible choices.

Spousal Monthly Income Limit

The Minimum Monthly Maintenance Needs Allowance (MMMNA) for Long-Term Care Medicaid allows non-applicant spouses with little (or no) steady income to take some (or all) of the applicant spouse’s income for living expenses. The MMMNA is $2,288.75 (effective July 1, 2022 – June 30, 2023. If a non-applicant’s monthly income is under $2,288.75, income can be transferred from their applicant spouse, bringing their income up to this level.

The MMMNA essentially ensures that low-income non-applicants have enough regular income to survive on their own based on a formula comparison with the Federal Poverty Level.

Some examples:

• A retired, non-applicant wife has a monthly income of just $1,750 via Social Security. She is eligible to transfer the difference — $538.75 — of the applicant spouse’s monthly income.
• A working, non-applicant spouse has a monthly income of $2,400 between part-time employment and Social Security. They are over the minimum and ineligible to transfer income.

Both Spouses Applying Jointly

Both spouses seeking Long-Term Care Medicaid eligibility makes matters easier. Both spouses need long-term care, so both must have income and assets at or below limits. The CSRA and MMMNA are no longer considered.

Care for both Institutional/Nursing Home Medicaid and Home and Community-Based Services Medicaid cap joint assets at $3,000 and combined income at $5,046 per month (or $2,523 per spouse).

We Can Help with Your Medicaid Eligibility & Asset Protection in Florida

Caregiver Support & Resources, LLC works with elder-law attorneys – most notably Peebles & Gracy, P.A. of Dunedin, FL – and we can legally and ethically protect people’s assets to help them qualify for Medicaid and VA attendance. 

Medicaid, unlike Medicare, will cover most long-term care costs. Once we obtain Medicaid eligibility, if you remain within the Medicaid guidelines, you can retain eligibility the rest of your life. The same goes for VA aid and attendance.

Transitioning to higher levels of care shouldn’t be fiscally constraining – much less poverty inducing. A little bit of planning helps families and future generations to rest easy today knowing financial matters are covered tomorrow.

(Editor’s Note: Caregiver Support and Resources, LLC is not a law office. Maureen Rulison is not an attorney. The information contained in this blog is not to be construed as legal counsel or advice or substituted as such in any U.S. state, territory, locale or foreign state where it can be accessed. Rather, this blog is meant only to educate elders, care partners and families as to legal processes around life care planning.)

By Maureen Rulison
Caregiver Support and Resources, LLC

Planning for every part of the life journey is never easy. Many of us retire and think the planning’s done. But there’s even more to factor in a strong, comprehensive life-care plan that factors your (and/or your loved one’s) care needs and dignity through the end – and beyond.  

Here at Caregiver Support and Resources, LLC, we build plans that empower care decisions to the right people – you and yours. The life-care plan isn’t just a means to “the end.” It’s a roadmap to prepare for unexpected emergencies, build financial security, and provide the comfort and LIFE WORTH LIVING to which we are all entitled.

A Great Life-Care Plan Has a Lot of Moving Parts

Numerous elements should comprise a life-care plan, which lays out what will be done, when, why and by whom. It factors everything that can – and should – happen. We’ve said before there should generally be 9 parts to a great plan, but each individual and family is different. (So if your life-care planning takes 15 extra parts, so be it!)

In a nutshell, this document spells out everything that needs to happen as care-partner teams navigate the uncertainties of advancing years, health conditions, financial and legal realities, and end of life. 

Even though everything is clearly laid out, make sure the plan is flexible. Be sure to anticipate changing realities, needs and wants over time. Care partners and responsibilities may change. Unanticipated medical diagnoses may arise. Financial security can teeter on the brink.

In general, the following are strong elements to include.

1. Care-Partner Team

Let’s begin with the circle of support surrounding the person(s) receiving care. Members may consist of family, friends and professionals in the continuum of care (primary care physicians, specialists, mental health counselors, assisted-living administrators, etc.). The team may be expansive, or it may be a team of one. 

The non-negotiable: the team must adopt a spirit of mutual cooperation and accept joint responsibilities. There are opportunities to give (and receive) care by everyone:

• A sister may tackle financial needs.
• A son may stop by to prepare meals and sort medications for the month.
• A neighbor may visit frequently for coffee breaks (aka wellness checks).
• A husband may assist with bathing and bedtime routines.

Your care-partner team may also include non-traditional and spiritual care methods. Some families prefer life-care plans that honor their religion and faith, with a clergy member or spiritual adviser assisting appropriate areas. 

2. Medical Care

Health is the most important factor – even if it may be deteriorating or failing. Medical concerns can arise in good health and bad. Illness can derail even those who seem the most healthy. 

Your life-care plan must factor anticipated health and dietary needs. These may vary person by person, year to year, month to month, or even day to day. So the plan must lay out what’s to happen in the status quo and when health matters inevitably change.

3. Financial & Legal Protection

Achieving a LIFE WORTH LIVING is so much easier when all the “loose ends” are handled. So let’s make one of the first things tackling the immense stress of financial and legal uncertainties. You want to know your “house is in order” to ensure legal control if/when the individual becomes incapacitated and protect assets for future generations. 

Ideally, official documentation will be prepared well before “when the time comes.” It’s more than “who gets what” or who chooses to “pull the plug.”

Needs may include:

• Medicaid and VA planning (with asset protection)
• Estate planning
• Living will (or advance directive) 
• Power of attorney
• Health care proxy
• Last will and testament

As always, get it in writing! Get it done early, when everyone has a calm mind about the future, less inhibited by reactionary biases. 

4. Living Situations

Home is where the heart is, but that may not be the case if/when medical concerns worsen. A strong life-care plan defines where your loved one will reside, when and why. 

It should have a Plan A and contingencies for both anticipated and unforeseen variables. For instance, Plan A may be that your Dad lives at home with your Mom, but Plan B might include options for Mom entering memory care when her dementia takes a turn, while Plan C mobilizes home-care resources for Dad remaining at home before moving to join her in Plan Z.

Moving to some sort of assisted living or advanced care isn’t always inevitable, but it is highly probable. More than 800,000 Americans reside in assisted living facilities – even more in advancing levels of skilled nursing. The trick is knowing when to make that call. When you or your loved one needs full assistance walking, bathing and toileting, that’s usually a good sign to go.

5. End-of-Life Care

We all owe God a death. That’s reality. But less than 40% of adults actually prepare for end-of-life care. And that’s a shame, considering it may be a prolonged, painful experience – even for the healthy.

Hospice care is a great resource for individuals with terminal illnesses expected to live six months or less, providing comfort and support on the journey to the end. For those expected to live longer in a debilitating condition, palliative care provides many of the same comfort services. 

(Related reading: What’s The Difference Between Hospice & Palliative Care? And Don’t Wait for Important Conversations About Hospice.) 

6. Person-Focused Care

It begins with the very language we use. Words are our most powerful tools. They can help or cause damage. Words can empower or place the care recipient in a weakened position. “Person-centered” or “person-focused” is the name of the game. 

Referring to a person as a “care partner” rather than a “caregiver” is a more calming and equitable relationship. While in the common vernacular, the term “caregiver” implies authority. Similarly, calling someone a “patient” connotes placement and dependency versus a “resident” who directs their care.

7. Community Resources

Extending to the outer circles of the care-partner team and beyond, many communities have ample resources (if only one knows where to look). Great care is a team effort. Community care options, including professional agencies, may include:

• Home care
• Respite care
• Counseling 
• Real estate
• Spiritual and faith-based care
• Living transitions and logistics
• Legal planning
• Even cleaning and cooking

In addition to part of our patient advocacy and life-care planning, we provide referrals to great resources in the Tampa and Clearwater, FL, areas.

8. Patient Advocacy

Which segues nicely to this point. Patient advocacy is another available resource for a well-rounded life-care plan. It’s your one-stop shop for EVERYTHING your loved one and care partners need. 

Our loved ones will be faced with many important decisions. An experienced Patient Advocate will know each required step for your loved one’s physical, emotional and financial well-being. As a Board-certified Patient Advocate in the State of Florida, I work with care-partner teams to support every step of the care journey.

9. After Care

The end has come, and the family is grappling over the loss of a loved one. Whether your loved one passed in peace or struggled mightily, the death experience can be jarring for everyone involved. The emptiness and sorrow can be incredibly strong, especially for close family and friends. Sometimes only counseling can work through such powerful feelings.

Memorial services and other final arrangements, as well as fulfillment of financial and legal responsibilities should also be included in a life-care plan. Alongside our community partners, we provide direct after-care support and referrals after a death. 

Let’s Build a Life-Care Plan for a Life Worth Living

As a professional life-care planner and a Board-certified Patient Advocate, I assist individuals and their care-partner teams every day. And then I come home to fulfill our life-care plan with my life partner/care partner, Brian. If you need help, Caregiver Support and Resources, LLC can help you from beginning to end. Email me at maureen@caregiversupportandresources.com.

You wake up in the morning to a mountain of primary caregiver tasks. Your loved one needs breakfast. This week’s medications must be sorted. Shoot, the laundry’s still in the dryer! One of their doctors left you a voicemail when you managed a quick bathroom break. 

And that’s just a morning in the life of a primary caregiver. Through the years as a personal care partner to my life partner/care partner, Brian – not to mention my life as a professional patient advocate – the most descriptive adjective for this is FRENETIC. All day, every day. So many fires to put out. 

Providing. Assisting. Coordinating. Advocating. Praying. Being a second set of eyes and ears. Remembering when they can’t. Making time for self-care. And so many do this … alone. Roughly two out of three primary care partners (64%) feel isolated and more than four in five (84%) wish they had help – particularly from family.

Need Help? Primary Caregivers Must Advocate For It

Here’s another word that’ll sound familiar: RESENTMENT. It’s powerful. (It often overshadows another word – UNDERSTANDING – although most primary caregivers are justified in believing close family and friends could do more to help.) Primary care partner responsibilities for elders often fall disproportionately on an adult child, probably a daughter. 

Unfortunately, care partners who view themselves as secondary often shy away from (or avoid entirely) their duties. The reasons for this may be legitimate. Some live far away. Many still work and must raise families of their own. Even more don’t know what to do, even if they agreed initially to help the care-partner team. They don’t want to get in the way. Their own guilt may prevent them from vocalizing uncertainties or circumstances.

Do you, as the primary care partner, know all this? Not without communication. Here’s an effective (albeit old-school) way to open the discussion: write a letter to the unsupportive team member(s).

Open the Care Partner Dialog with a Hand-Written Letter

Why a hand-written letter? It’s different. It’s not a text message, social media SOS or call that can be easily ignored – or put off to the point of being ignored. Receiving a personalized letter in the mail may be intriguing or even shocking. The recipient is more likely to open it, read thoroughly and thoughtfully consider its contents. (They’ll probably even read it twice.)

You may be wondering, “Where do I start?” or “How do I construct this letter?” Valid questions, especially with strong feelings and family relationships at stake. 

Experts suggest these three easily understood approaches for primary caregivers to effectively write a letter asking for support.

1. Don’t Attack

When you finally sit down to write, all your feelings will surface, perhaps after being trapped inside for many years. You may feel compelled – even justified – to let it all pour out. 

“Where have you been?” “How could you not care?” “You have a responsibility.” “You’re hurting him/her.” “You’re breaking our hearts.” 

Your feelings are likely valid, and there’s certainly room for genuine truth and feeling. But firing off a list of grievances is the least diplomatic approach. Personal attacks will cause defensiveness. So write compassionately and try to understand (because, after all, you aren’t living their life and confronting their daily stressors). 

Write this letter with kid gloves. You’re simply opening a dialog that brings results: the help you need as a primary caregiver.

2. Make a Specific Appeal

Continuing this no-drama, straight-to-the-point approach, ask for the things you and your loved one need SPECIFICALLY. There’s no room for ambiguity when urging an uninvolved care partner to perform specific tasks. 

If your loved one and the care-partner team built a comprehensive life-care plan, recap its details (to jog the memory, if needed) and list their individual expectations. Stick to the facts.

“Before Mom’s health declined, you agreed to help with X, Y and Z. So far you have not done these things.”

Then put the ball in their court.

“If you can’t do these things or if your role(s) must change, please let me know. If you can, you’re welcome to help out.”

Minimize chances for argument. Request a phone call or in-person visit to discuss. Your letter may open the door to the care partner admitting they’re overburdened at work or facing financial issues. That’s fine. At least now you know to adjust.

3. Personalize Your Message

You’re all on the care-partner team because you truly care. You care for your loved one. You likely care (or have cared) deeply for other team members. 

I’ve seen so many families ripped apart, with members vowing never to speak again following their loved one’s passing, all because care partners failed to communicate. Admittedly, it’s common for primary caregivers to CHOOSE to shoulder the burden alone due to pride or an “I know them best” mentality. That’s no reason to destroy a happy family. 

Talk it through! Mention the scenarios that you struggle with, how their absence affects everyone. Include positive qualities about your relationship with the absent care partner and note how they could benefit everybody involved. 

“You’re such a great cook. Dad would love it if we could get together for regular family meals again.” Or, “You’re amazing at organizing. That would help us clear out the clutter when Carol moves to assisted living.”

Primary Caregivers: Better Communication Starts with You

I know. Writing this letter is ONE. MORE. THING. you have to do. But primary care partners must eventually decide to stop beating their heads against a wall and advocate for more help. Sometimes the help won’t come. And that’s OK, at least you now know you’ll need to seek new people and resources for the care-partner team.

Caregiving is a labor of love. It’s demanding. Ask for (and accept) help. Sometimes, swallowing your pride is the best thing – for you and the care recipient. Get on the same page and come together for the sake of your loved one. If you need help writing your letter, contact me at maureen@caregiversupportandresources.com.