Banks need to respect their customers’ right to control their own account

Gilliam v. BB&T

We are filing this lawsuit with the law firm of Kelly and Crandall to force BB&T and other banks and credit unions to follow a 40-year old federal law and to respect their customers’ right to control their own accounts.

Millions of consumers authorize companies to automatically deduct payments from their deposit accounts for recurring expenses such as subscriptions, memberships, a mortgage, credit card, or other monthly bills. To ensure that payments are timely, companies often seek out consumer permission for these preauthorized charges.

So, you just contact your bank or credit union and tell them no more automatic debits to that company and they take care of it, right?

Too often, the answer is NO

The Virginia Poverty Law Center operates a free predatory loan hotline.  We get hundreds of calls from people with internet loans.  Every internet loan we have seen is illegal in Virginia and we tell callers how to stop the illegal lender from debiting their bank account (because every borrower has given the lender the authority to debit their account for payments).  More times than we can count, the person calls us back and says the bank or credit union won’t or can’t stop the debits.  They usually tell them must pay for a Stop Payment Order that likely won’t work.  So the bank ends up helping the internet lender trap their own customer into an illegal loan.

Congress enacted the EFTA in 1978 and said this:

“The EFTA also “sets minimum safeguards for consumers who arrange for regular payments (such as insurance premiums or utility bills) to be deducted automatically from their bank accounts.” These safeguards protect the consumer’s control over his or her own account”

Gilliam v. BB&T is a class action lawsuit.  When the EFTA was passed in 1978, the House Committee on Banking, Finance and Urban Affairs stated:

“The potential of class actions is symbolically as well as practically important to consumers and to industry. Both groups will assess the seriousness of Congressional purpose on whether class-action suits are provided for in this EFT legislation. Included, no one can doubt congressional intent that institutions provide EFT services only in a beneficial, responsible manner. Excluded, the opposite may be assumed.”

Let’s hope the bank doesn’t try to thwart the will of Congress by attempting to force us out of court and into a biased and secret arbitration system.

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Critter Corner: Tips for Affordable Care Act Open Enrollment

Dear Magic,

I will be shopping for 2018 health insurance through the Affordable Care Act (ACA) exchange. I can tell it’s going to be complicated this season, since it was shortened to just 45 days. Do you have any tips for this year’s open enrollment?


Paul Lissy-Shopin


Dear Paul,

Open Enrollment begins on Wednesday, Nov. 1 and ends Wednesday, Dec. 15, which is a tight time! Eight states and Washington, D.C., however, have extended Open Enrollment beyond Dec. 15. Unfortunately, Virginia and Maryland are not among those states.

Not only will the time frame to enroll be cut in half, but government assistance to help people purchase plans wisely will also be reduced. The site will be shut down every Sunday from midnight to noon for maintenance during Open Enrollment. And, some health insurers will send out renewal notices later than normal, because they’ve been waiting for clarity from the Trump administration about the rules for 2018.
With these and other changes, what are some tips for Affordable Care shoppers like yourself?

  1. Start shopping early. Since there is a shorter window this year and reduced help, the sooner you begin looking, the better.
  2. Use to find an insurance agent or broker. You can also phone the Marketplace Call Center toll-free 24-hour hotline for general information (800-318-2596).
  3. If you bought a policy through the ACA last year, you may not want to simply let your health insurer automatically renew it. The plan’s coverage, doctor network, deductibles and premiums may have changed. So, you may want to compare your plan to what else is being sold where you live.
  4. Look beyond premiums when comparing policies. You’ll want to look closely at the deductibles and co-payments, so you’ll know how much you’ll owe out-of-pocket. And you’ll want to see which medical services are covered (and which aren’t) as well as which doctors you can see.
  5. Decide whether to go for a Platinum, Gold, Silver, or Bronze plan, based on whether you qualify for a premium tax credit. A Gold or Platinum plan could be your best bet if you see doctors frequently or have a chronic illness, because of its lower deductible.
  6. Make sure you have some health insurance for 2018. Otherwise, you’ll owe a penalty. In 2017, that was $695 or up to $2,085 a family. The Internal Revenue Service has reaffirmed its plans to levy these penalties; the amounts will rise with inflation for 2018.

Hop this was helpful!


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Simplifying the Medicare Process

Q. I am a few months away from my 65th birthday, and I am aware that it is time to begin thinking about enrolling in Medicare. I started researching Medicare online, and I realized that enrollment is much more confusing than I anticipated. I’m not sure where to begin, who to contact, and which plan is best, and I would hate to make a costly misstep. Is this common and do you have any tips for people like me? Thanks!

A. Medicare Open Enrollment began a couple weeks ago and goes through 12/7/17. It’s a good idea to begin educating yourself about Medicare at least three or four months before you apply, as it seems you are already doing. Many who don’t do their research in advance find themselves quite confused when they are ready to enroll.

A recent analysis of AARP’s helpline data concurs with your experience that many people are struggling to navigate the complexities of the Medicare program and to afford their coverage. The report, “Medicare Trends and Recommendations: An Analysis of Call Data from the Medicare Rights Center’s National Helpline,” recommends laws requiring earlier and more detailed information to newly eligible Medicare beneficiaries, as well as other policy changes.

Below are some tips for finding your way through Medicare once you’re 65 or older. With a careful approach, you can become knowledgeable about Medicare and the rules and get all the benefits to which you’re entitled.

  1. Who to contact: Everyone signs up for Medicare through the Social Security Administration, and that agency will be your contact point for questions as well as your actual registration.
  2. When to start: You can begin the process of applying for Medicare up to three months before you turn 65. At that point, you can contact Social Security by phone, visit your local Social Security office or sign up for benefits online, depending on your preference.
  3. Which plans are available: The types of coverage you need to understand include: Part A (covering medical facilities); Part B (covering medical providers); Part C (Medicare Advantage plans, which mimic private insurance plans and function as an alternative to a Part A/Part B package); and Part D (prescription drug plans).
  4. What does the terminology mean? The government’s website is a good place to start. has a primer or you can watch a six-minute video by a Medicare trainer on Parts A and B.
  5. Find someone to assist you with your research (if you think that would help). A trusted family member or friend might be of assistance, especially if he or she is someone who’s already dealt with Medicare and health insurance issues. He or she could be a good resource if you feel confused or intimidated by Medicare’s lingo and long list of regulations. If you’re a Virginia resident, no-cost insurance counseling assistance is available through the Virginia Insurance Counseling and Assistance Program (VICAP). To get in touch with a VICAP counselor in your area, contact your local Area Agency on Aging (AAA); you can find your local office here. If you’re a Maryland resident, the same service is available through the Maryland State Health Insurance Assistance Program (SHIP); can find a local counselor here. DC residents can make use of the George Washington University Health Insurance Counseling Project by calling (202) 994-6272.
  6. Call Social Security with any specific Medicare questions. If there is something you don’t understand or if you are unsure how the rules would affect you, you can also call Social Security and ask. Stay on the line until all your questions have been answered and all your doubts erased. The phone number is 800-772-1213. Similar to other government offices, Social Security can be difficult to reach. Be sure to pick the right time to call so you can avoid long delays. The busiest times for Social Security (and the hardest times to get through) are on Mondays, Fridays, early in the morning and on, or near, the first of the month. The best time to call for information or to let Social Security know about your Medicare plans is from Tuesday through Thursday, preferably between 10 a.m. and 3 pm Eastern Time. If you do get put on hold during those times, it shouldn’t be for long.
  7. Don’t stress yourself out. Applying for Medicare coverage and benefits is not as scary or difficult as you think. Despite the bureaucracy and confusing terminology, there is a logical, rational system that can be understood once you’ve done your research, asked questions, and asked for assistance (if needed) to get a better understanding.

A couple important things to understand

You mentioned costly missteps in your question. Below are some mistakes that others have made that you should try to avoid or they could become costly:

  • People who fail to enroll in Medicare Part B when they first should will face lifetime penalties, a coverage gap and disruptions in care. The penalty is hefty: an extra 10% for each full year you could have had Part B but didn’t apply and were not covered beyond 65 by health insurance from a current employer.
  • If you have primary coverage through a current employer (your own or your spouse’s), you can delay Part B without penalty until the job ends. If your coverage is from a small employer (fewer than 20 employees) or a former employer, find out how it works with Medicare. Check out the AARP article “Medicare When Working Beyond 65” to avoid complex problems that can arise in coordinating Part B and an employer’s plan.
  • Medicare doesn’t cover everything. Decide whether traditional (also called original) Medicare and a supplement Medigap plan or a Medicare Advantage plan, which combines Medigap and prescription coverage, is best for you. Learn more about Medicare Advantage plans and search for a Medigap plan here.

Remember, No Matter What Plan You Choose, Medicare Doesn’t Pay a Penny for Long-Term Care

Medicare and private health insurance ONLY pay for short-term therapy and skilled care in a nursing home for up to 100 days; they don’t pay for long-term care. For long-term care, the main government benefit is Medicaid, but medicaid laws are the most complex laws in existence! There are strict financial requirements that must be met in order to qualify for Medicaid, including the requirement of having less than $2,000 of countable assets to your name. However, with proper Medicaid asset protection planning, almost everyone can qualify for Medicaid when needed, without having to be broke or to first spend down your life savings. If you or a loved one is nearing the need for long-term care or already receiving long-term care, please call us to make an appointment for a no-cost initial consultation:

Fairfax Medicaid Planning: 703-691-1888
Fredericksburg Medicaid Planning: 540-479-1435
Rockville Medicaid Planning: 301-519-8041
DC Medicaid Planning: 202-587-2797

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Please Stop Feeding Me!

Last weekend, I presented at the Positive Aging Fair, and my PR Director, Renee, staffed our expo booth. Renee told me and Jeannie about another booth at the expo that was particularly memorable, because the representative brought an oven and was baking cookies on-site. Upon speaking with him, Renee said that he does the same thing at the memory care unit where he works, because it jogs the memory of those with dementia and reminds them to eat.

This seemed like a great idea to Renee, who has several family members with dementia, but couldn’t even fathom her loved ones forgetting to eat. It certainly happens, though. And, sometimes, when it does, the patient is spoon-fed by staff. This could be a helpful way to give a person with dementia the nutrition he or she needs to stay alive. However, what if the person didn’t want to be fed at all, and he or she couldn’t communicate that?

Let’s take, for instance, Nora Harris, a librarian and scholar in Oregon who was diagnosed with early-onset Alzheimer’s at age 56. Nora had no desire to be kept alive with measures to prolong her life, including artificial nutrition and hydration. She even drafted an advance directive to that effect.

Nora’s husband, Bill, contended that his wife’s Advance Medical Directive document covered oral assisted feeding, too. To comply with his understanding of her wishes, he actually went to court last year to try to force staff at the center to stop spoon-feeding Nora, saying the practice violated his wife’s wishes and her legal documents. According to Bill, “Nora never wanted to live like this.”

Bill took the matter to court to do what he could to make sure his wife’s wishes were respected. However, a local judge sided with the state’s long-term care ombudsman who said that state rules to prevent abuse required the center to offer residents three meals each day and provide help eating, if needed. So the facility where Nora resided kept spoon-feeding her, even as Nora’s kidneys failed and she became bed-bound. Bill fought for eight years for his wife’s wishes to be followed, but was ultimately unsuccessful.

The Right to VSED

Nora Harris, who passed away a couple weeks ago, has turned into a central character in the ongoing debate over advance directives and dementia, and voluntary stopping eating and drinking (VSED). The issue at the center of the controversy is whether patients with dementia and other progressive diseases can stipulate in advance that they want oral food and liquid stopped at a certain point, hastening death through dehydration. The other issue is whether people who still have mental capacity can refuse food and water, usually resulting in death within two weeks.

These are some of the issues that affect whether or not VSED is ethical and legal:

  • Is it torturous or peaceful? Advocates for VSED contend that, with proper medical support, it can result in a peaceful death that allows patients control over their own fate. Critics say the practice amounts to torture and that it will lead to starvation of elderly, disabled, and mentally ill people.
  • What if people still open their mouths to accept nourishment? Unlike medical aid-in-dying, VSED doesn’t require a law or a doctor’s approval. The legal and ethical question remains about those who open their mouths to accept food and fluids, as Nora Harris did until her last days. Even though research shows that feeding somebody with end-stage dementia will not prolong their life, if a patient accepts food and swallows it, should it be incumbent on caregivers to feed him or her?
  • Are the laws clear? Nearly two dozen states have laws that address assisted feeding, including many that specifically prohibit withdrawing oral food and fluids. Other states address only artificial feeding or are unclear or silent on the issue
  • What if it’s stated clearly in a person’s Advance Medical Directive document that they desire VSED? Right now, only one state — Idaho — appears to sanction withdrawal of assisted feeding by a health care proxy “in accordance with a valid directive,” according to a July analysis compiled by Charles Sabatino of the American Bar Association. However, with more than 5.5 million people living with dementia in the U.S., requests about stopping assisted feeding are becoming more common, and the issue has been given more attention. It will be interesting to see how the laws change regarding honoring advanced wishes for VSED!

Putting VSED wishes in you Advance Medical Directives

Advance medical directives that tell caregivers to continue or withdraw artificial nutrition and hydration provided through feeding tubes or IV lines are common. However, most don’t mention assisted oral feeding. This is something new that the Farr Law Firm is incorporating into its advance medical directives; it may not be enforceable under current law, but you can still make your wishes known for the future in the event the laws change, since this is a rapidly evolving area of the law.

What if you want to indicate in your advance directive what should happen with regard to spoon feeding if you have Alzheimer’s? Do you want to be spoon-fed if that is the only way you can eat or drink? The only way to ensure that your incapacity and estate plan truly reflects who you are, what you care about, and what you have today is to have your documents reviewed and updated as needed. The Farr Law Firm’s Lifetime Protection Program ensures that your documents are reviewed and updated annually, so that they will always reflect your current wishes and be up to date with the ever-changing laws.

If you are a member of our Lifetime Protection Program, please don’t hesitate to call us for a no-cost update to your advance directive if you want to add language about spoon feeding, or you can wait until your annual renewal to make the change. If you’re not yet a client and you don’t have an advance medical directive, call us to schedule a no-cost initial consultation:

Fairfax Elder Law: 703-691-1888
Fredericksburg Elder Law: 540-479-1435
Rockville Elder Law: 301-519-8041
DC Elder Law: 202-587-2797

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A Parent Can Name Ex-Felon Son as Executor, Power of Attorney & Fiduciary

By Fredrick P. Niemann, Esq. of Hanlon Niemann & Wright, a Freehold, NJ Estate Planning & Elder Care Attorney

My client is updating her estate planning. She’s 60 and divorced. At age 19 her son was convicted of a felony and spent a year in prison. Twenty years later he’s responsible, trustworthy, has a job and a family. She wants to name him personal representative under her will and power of attorney. However, friends tell her he can’t serve because of that conviction. He is her only beneficiary with no meaningful next of kin, so he wouldn’t be responsible for anyone else’s funds. Can she get around this?

New Jersey statutes are clear: An individual who has been convicted of a felony may serve as a personal representative. The number of years that has elapsed since conviction is immaterial. Even though her son is her only heir, and her estate planning does not include any other beneficiaries, the state does not limit a former felon’s eligibility. Other states have laws designed to protect not just other beneficiaries, but also creditors who may have claims on your estate. That’s why a felon can’t serve in those states.

At this juncture, I recommended that my client talk with her son to discuss who else might serve as a personal representative. Alternatively, a lawyer could help the son apply for an expungement. If obtained, the judgement would further enable him to act as his mom’s personal representative. An expungement might also help her son get jobs currently not available to him because of the past conviction.

To discuss your NJ Estate Planning matter, please contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at  Please ask us about our video conferencing consultations if you are unable to come to our office.

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Medicaid CCC Plus Rolls Out in Northern Virginia on December 1, 2017

Q. My mom, who you recently did asset protection for and got qualified for Medicaid, recently received a letter in the mail from the Virginia Department of Medical Services that welcomed her to Commonwealth Coordinated Care Plus (CCC Plus), Virginia Medicaid’s new, required managed care program.

The letter mentions that her mandatory enrollment in the CCC Plus Medicaid Health Plan will give her all her Medicaid health care, long-term services and supports, and prescription drug benefits, and that she will have a care team that works with her and her providers for primary care, mental health, hospital, nursing facility, and specialty care; and that she will have the added benefit of a care coordinator.
Can you explain more clearly what this is all about and what these changes mean for my dad? My dad will likely need long-term care in the not-so-distant future, and also wants to know how this will affect him if he qualifies for Medicaid through your office, and wants to know if there are other alternatives to CCC Plus. Thanks for your help!

A. Commonwealth Coordinated Care Plus (CCC Plus) is a new Medicaid program that provides medical, behavioral, substance use disorder, and long-term services and supports all under one program. CCC Plus is being phased in by region across Virginia, as follows:

Tidewater – August 1, 2017
Central – September 1, 2017
Charlottesville/Western – October 1, 2017
Roanoke/Alleghany – November 1, 2017
Southwest – November 1, 2017
Northern/Winchester; December 1, 2017

The letter your mom received was from the Commonwealth of Virginia Department of Medical Assistance Services. It welcomed her to CCC and should have included the following information:

Your CCC Plus Medicaid health plan is SAMPLE MEDICAID HEALTH PLAN. Your coverage will begin October 1, 2017.
Your Medicaid ID # is 00999999999

If this is the letter that your mom received, below is some information about the CCC program, her next steps, and other options:

Who is Covered? 

Medicaid individuals who meet CCC Plus participation criteria are required to participate. You are eligible for CCC Plus when you have full Medicaid benefits, and meet one of the following categories:

· You are age 65 and older
· You are an adult or child with a disability
· You reside in a nursing facility (NF)
· You receive services through the CCC Plus home and community based services waiver — formerly called the Elderly or Disabled with Consumer Direction (EDCD) Waivers and the Technology Assisted Waiver.
· You receive services through any of the three waivers serving people with developmental disabilities (Building Independence, Family & Individual Supports, and Community Living Waivers), also known as the DD Waivers.

Health Plan Choice

Your mom’s CCC Plus health plan will give her all of her Medicaid health care, long-term services and supports, and prescription drug benefits. She should have a care team that works with her and her providers for primary care, mental health, hospital, nursing facility, and specialty care.

In the initial letter that your mom received, she was presented with the ability to choose a different health plan or keep the assigned health plan. A health plan comparison chart should have been included in the mailing to help her decide. If she opts to choose a different health plan, she must do so within 90 days of her enrollment date (which is included in the letter) by calling the CCC Plus Help Line at 1-844-374-9159, or going online at and requesting the change. She may also call the help line to find out if her doctor and other health care providers are in the network of her new health plan. If she wants to keep the Medicaid health plan that was chosen for her, she does not need to do anything. She will receive a health plan ID card. She should keep her Medicaid card, and show both cards when she gets care.

The Care Coordinator

As a CCC Plus member, your mom will be assigned a Care Coordinator through her health plan. The Care Coordinator is supposed to work with her and her providers to make sure she is receiving the services she needs. If she is enrolled in Medicare, her Care Coordinator can assist her with coordinating her Medicare and Medicaid benefits.

Your mom’s Care Coordinator can help her understand and access her plan benefits.

Another Alternative to the CCC Plus Program

As mentioned previously, enrollment of all CCC Plus eligible Medicaid members into the CCC Plus program is required. If you meet certain eligibility criteria, however, the Program of All-Inclusive Care for the Elderly (PACE) may be another option. This program helps people with their health care needs in the community instead of a nursing home or other facility.

The PACE program uses an adult day-care model to deliver the entire continuum of care and services to those with chronic care needs, while maintaining their independence at home for as long as possible. PACE was created as a way to provide family, caregivers, and professional health care providers the flexibility to meet health care needs and to help those who wish to continue living in their own homes.

If your mom or your dad are age 55 or older, they may qualify for PACE. For those in the Fairfax area, InovaCares for Seniors Fairfax is the sole PACE provider, and they can be reached at 703-239-5888, or by email at To learn more about PACE, go to: The website also has a “PACE Finder” to will help you find out if there is a PACE site in your area. If you qualify for and enroll in PACE, you will be “disenrolled” (dropped) from your CCC Plus health plan.

Planning for Long-Term Care for Your Father

You mentioned that your father is interested in applying for Medicaid soon, to help pay for the catastrophic costs of long-term care ($10,000 – $14,000 a month in the Metro DC area). As you know, Life Care Planning and Medicaid Asset Protection is the process of protecting your assets from having to be spent down in connection with entry into a nursing home, while also helping ensure that you or your loved one get the best possible care and maintain the highest possible quality of life, whether at home, in an assisted living facility, or in a nursing home. Your father should call us as soon as possible to make an appointment for his own planning:

Fairfax Elder Law: 703-691-1888
Fredericksburg Elder Law: 540-479-1435
Rockville Elder Law: 301- 519-8041
DC Elder Law: 202-587-2797

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Critter Corner: The CCC Program When You’re Already in a Nursing Home

Dear Angel,

My mother received a letter in the mail about the mandatory Commonwealth Coordinated Care Plus (CCC Plus) Medicaid Managed Care Program. However, she is in a nursing home. Can she remain living at her current nursing facility, and what if anything will change?

Al Reddy-Thayer

Dear Al,

Commonwealth Coordinated Care Plus (CCC Plus) is a new Medicaid program that provides medical, behavioral, substance use disorder, and long-term services and supports all under one program. Medicaid individuals who meet CCC Plus participation criteria are required to participate.

If your mother resides in a nursing facility at the time of her CCC Plus enrollment, she may remain in her nursing facility for as long as she continues to meet the Medicaid level of care requirements for nursing home care. Even if her nursing facility does not contract with her health plan, she can remain in her nursing facility. In fact, efforts will be made to assign her to a health plan that contracts with the nursing facility where she lives.

If Medicaid determines that she continues to need nursing home level of care, she also has the option of choosing a different nursing facility or returning to the community with some services in place to help her. Her Care Coordinator should work together with the staff members of the nursing facility to develop her plan of care, monitor the care she receives, and help with discharge planning, if applicable.

If you or your mother would like help from a CCC Plus Advocate in making a decision about CCC Plus options or in resolving problems about plan benefits, she or you can call the Department of Aging and Rehabilitative Services, Office of the State Long-Term Care Ombudsman, at 1-800-552-5019.

Hope this is helpful!

Purrs and hugs,

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Come Hear Evan Speak This Weekend at The Positive Aging Fair!

This Sunday, Evan Farr will be speaking at The Northern Virginia Positive Aging and Wellness Fair. The fair will be held at the Inova Center for Personalized Health Conference Center at 3225 Gallows Road (across from the Inova Fairfax Hospital and formerly the Exxon Mobil campus) in Fairfax, VA from 8:45 am to 4 pm. Evan’s session will be held at 11:30am-12:30pm, and the description is as follows:

Medicaid Planning: Protect Your Assets
by Evan Farr, Certified Elder Law Attorney

Long-term care is catastrophically expensive, averaging $12,000– $14,000 a month for a nursing home in the Metro DC area. With proper Medicaid asset protection planning, almost everyone can eventually qualify for Medicaid when needed, without having to be broke or to first spend down your life savings. This workshop will explore how to protect your assets and obtain valuable Medicaid benefits to pay for long-term care.

The fair includes more than 30 interactive and informative workshops promoting active aging through healthy lifestyles that may help you live longer, more independently, and more positively. Bob Levey, former columnist for The Washington Post, is the keynote speaker. There will also be a trade show featuring more than 35 exhibitors — including The Farr Law Firm, the non-profit Reiki Outreach Services for Elders (ROSE) founded by Evan Farr, along with numerous other nonprofits, and government agencies offering one-on-one assistance and resources. The fair is geared for adults 50+. Visit for more details and to register!

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Critter Corner: Does Medicare Really Not Care About Long-Term Care?

Dear Bebe,

I read in a couple of Mr. Farr’s blogs that Medicare doesn’t cover long-term care. I thought that it did cover some long-term care services. Can you clarify? Thanks!

Metta Caire

Dear Metta,

Medicare pays for health care for people age 65 years and older, people under age 65 with certain disabilities, and people of all ages with end-stage renal disease. Medicare only covers medically necessary care and focuses on acute care, such as doctor visits, drugs, and hospital stays. Medicare also covers short-term care and rehabilitation, such as physical therapy to help you regain your function, after injuries such as a fall or a stroke.

Medicare does not pay one penny, ever, for long-term care (often called custodial care) —which involves help with activities of daily living such bathing, dressing, and using the bathroom; nor does Medicare pay for supervision needed by those suffering from dementia.

What causes many people confusion is that Medicare will help pay for a short-term stay in a skilled nursing facility, for hospice care, or for home health care, but if you meet the following conditions:

• You have had a recent prior hospital stay of at least three days (3 midnights);
• You are admitted to a Medicare-certified nursing facility within 30 days of your prior hospital stay;
• You need skilled care, such as skilled nursing services, physical therapy, or other types of therapy.

If you meet all these conditions, Medicare will pay for some of your costs for up to 100 days (i.e., short-term care). For the first 20 days, Medicare pays 100% of your costs. For days 21 through 100, you pay your own expenses up to $140.00 per day, and Medicare pays any balance. Anything after 100 days is considered long-term care, and you pay 100% of costs for each day you stay in a skilled nursing facility after day 100.

In addition to skilled nursing facility services, Medicare pays for the following services for a limited time when your doctor says they are medically necessary to treat an illness or injury:

• Part-time or intermittent skilled nursing care: Physical therapy, occupational therapy, and speech-language pathology that your doctor orders , for a limited number of days;
Medical social services to help cope with the social, psychological, cultural, and medical issues that result from an illness. This may include help accessing services and follow-up care, explaining how to use health care and other resources, and help understanding your disease;
Medical supplies and durable medical equipment such as wheelchairs, hospital beds, oxygen, and walkers. For durable medical equipment, you pay 20% of the Medicare approved amount.
There is no limit on how long you can receive any of these services as long as they remain medically necessary and your doctor reorders them every 60 days.

Hospice care

Medicare covers hospice care if you have a terminal illness and are not expected to live more than six months, but you must first switch your Medicare into “hospice mode,” which means that Medicare will then not cover existing medications and procedures that are designed to improve your condition. You may receive hospice care in your home, in a nursing home (if that is where you live), or in a hospice care facility. Medicare also pays for some short-term hospital stays and inpatient care for caregiver respite.

You can learn more at Hope this is helpful!

Purrs and hugs,


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Has In-home Care Gotten a Lot More Expensive this Year?

Q. I’ve been a full-time caregiver for my mother for the past few years. Last year, when I noticed that my role was becoming more than I could handle myself, I started looking into in-home care. At the time, I decided against it because it was too expensive. This year has been particularly hard on me, and I could really use the assistance with mom. I decided it was time to spend the money and get my mother the help that she needs to continue to stay in her own home for as long as possible.

I called several home health care agencies in our area for quotes, and couldn’t believe what I was hearing. The cost went up so much since last year! Is this just happening locally, since everything is expensive here, or is it a national trend? I am beginning to get worried. Has assisted living and nursing home care also increased in cost, and most importantly, how can I afford the care that my mother needs now and will likely need in the future?

A. The increase you noticed in the cost of in-home care is not just local. It is happening across the country! Home-based services are increasingly getting more expensive thanks in part to ongoing labor woes of home health care workers, according to the latest Cost of Care Survey from insurer Genworth Financial.

From 2016 to 2017, the national median cost of home health aide services shot up 6.17% to $21.50 per hour — the most pronounced increase among the various care settings according to the survey.

Why the Cost Increase?

According to the New York Times, by current standards, an “in-home health care worker is likely to be a middle-aged immigrant woman, with maybe a high school education and little if any training, making $20,000 a year.”
Despite their critical importance to the well-being of tens of millions of aging Americans, a quarter of these aides live in poverty. The jobs are so unappealing that it is hard to keep workers in them. In fact, 4 out of every 10 leave the occupation entirely within a year, and there is a shortage of these workers in the entire field because of it. Many prefer the fast-food business.

“Home care is absolutely the bottom rung on the ladder, but home-care workers are the people that spend the most time with the client,” said Adria Powell, who runs Cooperative Home Care Associates, a worker-owned long-term-care agency in New York. Sadly, Paul Osterman of the Massachusetts Institute of Technology’s Sloan School of Management calculates that if nothing is done to draw more workers into the field, there will be a shortage of at least 350,000 paid care providers by the year 2040.

The increasing demand for long-term care services as our population ages coupled with a shortage of workers and rising labor costs, is why the cost of in-home care keeps increasing.

Other Notable Findings

In-home care services weren’t the only area where costs increased. Overall, the annual median cost of all long-term care services climbed an average of 4.5% from 2016 to 2017, marking the second-highest year-over-year increase for nursing homes and home care since the study began in 2004. These were some additional findings from the survey:

  • The national median cost for a one-bedroom unit in a private-pay assisted living community reached $3,750 per month, or $45,000 a year, according to the survey. That’s an increase of 3.36% from 2016 to 2017.
  • National median rates for semi-private room nursing home care increased 4.44% and hit $7,148 per month, and private room nursing home care reached $8,121 per month, a 5.50% increase.
  • For nursing homes, higher labor expenses and tightening Medicare rules have resulted in shorter hospital stays and sicker patients being sent to nursing homes for shorter rehab stays, driving up costs.
  • Room and board for assisted living communities has gone up to accommodate residents who are sick, but not sick enough to require nursing home care.
  • Luxurious amenities commonly found in private pay communities also increased costs of care.
  • About two-thirds of respondents in a companion survey to this year’s Cost of Care report said they “expect government programs to cover all or part of their long-term care costs.” The primary government benefit that pays for long-term care is Medicaid, which is why it is so important for people to do Medicaid asset protection planning after age 65, or earlier if there is any sort of disability in the family.

Paying for Long-term Care

With long-term care services being so expensive, how can anyone afford them without going broke or depleting their assets?  Are government programs enough to help pay the costs? Medicare will pay for skilled home health, but most home care and homemaker services are paid out of pocket. Medicare will also pay for limited skilled nursing care following a three-day hospital inpatient stay. But, Medicare does not pay one penny for long-term care!

Medicaid, on the other hand, has different income and functionality requirements. Medicaid is the single largest payor of long-term care costs because so many people can’t afford to cover the costs themselves, but what many people often don’t realize is, it is extremely difficult to qualify and the help of an experienced elder law attorney, such as myself, is absolutely essential.

Genworth includes the following extremely truthful quote in their survey findings: “It usually takes personal experience caring for a parent or other family member for people to realize the enormous costs associated with long term care and wake up to the fact that they themselves need to do a better job of planning ahead for how they will cover these costs.”

Planning for Long-term Care

Medicaid planning can be started while your mother is still able to make legal and financial decisions, or can be initiated by an adult child acting as agent under a properly-drafted Power of Attorney, even if your mother is already in a nursing home or receiving other long-term care.  In fact, the majority of our Lifecare Planning and Medicaid Asset Protection Planning clients come to us when nursing home care is already in place or is imminent.

Generally, the earlier someone plans for long-term care needs, the better.  But it is never too late to begin your planning.
To afford the catastrophic costs of long-term care without depleting all of her hard-earned assets, your mother should begin her Long-Term Care Planning as soon as possible. You both should also do Incapacity Planning and Estate Planning, if you haven’t done so already. Please call us to make an appointment for a no-cost initial consultation:

Fairfax Elder Law: 703-691-1888
Fredericksburg Elder Law: 540-479-1435
Rockville Elder Law: 301-519-8041
DC Elder Law: 202-587-2797

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