How Will You Be Cared For
Video Transcript: How Will You Be Cared For
It’s times like this that I really understood why it’s important to have a support staff and colleagues for planning around the Aid and Attendance Pension Benefit. While Jack (not his real name) was well organized, he knew he was in over his head and sought help. While Alyssa helped him organize some papers, Kathy brought him a glass of water and he was starting to look a little more at ease. Then he started in, talking faster than one of those disclaimers for a prescription drug you hear on the radio.
“Look, Jeff,” Jack said. “I know that my dad’s going to need help, and it’s going to cost money. But he is a Vietnam veteran, and I know there has to be some help for him from the V.A. I just don’t know how much, and I need to make sure that his assets are going to last. I know there’s some shifting around we can do with her accounts, but there seems to be so much conflicting stuff out there. What should we do?”
“Slow down for a moment,” I said, holding my hand up and talking deliberately slower. “Before we go into any of that, how is your dad doing?”
Jack looked a little taken aback. “I… didn’t really expect you to ask that,” he said, smiling. “Other people I have spoken to didn’t seem to know what they were talking about, but all they wanted to talk about were his assets and income.”
I smiled. “It’s a good thing you came here then,” I replied. “Before we can do anything about your father’s assets, we need to make sure we know what kind of care he needs. While I want to know what the medical professionals think, I first want to know how you think your dad is doing and what kind of help you think he needs. Is he in good spirits?”
Planning around the Aid and Attendance Pension Benefit has to be about more than assets, income, and medical reports. Unfortunately, many professionals push those other items aside and focus only on the money. That is one reason why my office works with The Senior Veterans Council who has a geriatric care manager, social worker, registered nurse, and other professionals on staff to provide evaluation advice and a care plan, and, to the extent our clients allow, we involve the family as well. After all, the decision on a parent’s long term personal care often involves the family as much as the veteran, spouse, or widow.
The different options available relate often to what is referred to as the Activities of Daily Living as well as the Instrumental Activities of Daily Living. These are medical/health care evaluations more officially done by a medical professional when needed, but a quick evaluation by a geriatric care manager can help guide the big discussion of where is best for long term care needs. While each situation is different and there are many customized personal care plans, there are four main living options:
Option 1—Companion Care: Companion care is when someone comes in to the home to help you continue to live more or less independently but providing assistance only with those activities where help is needed. Companion care can run the gamut from preparing meals, house cleaning, shopping and errands, all the way to assistance with washing and dressing. Companion care can also range from full time to providing a supplement to help from the family. In a lot of cases, this is a first stage of care that may be replaced by a more structured living environment if illness progresses. In many other cases, it is only a temporary measure to assist someone who is convalescing until they regain strength and mobility. In many cases, this is the type of care many veterans, spouses of veterans, or widow(ers) of veterans need financial help with in the form of the Aid and Attendance Pension Benefit.
Option 2—Move in with Family: While this is often a first reaction on the part of a family wanting to help as well as provide some cost savings, there are a lot of unanticipated difficulties. On the part of the person needing help, there are often strong emotional difficulties with having a lot of reliance on family members that they themselves used to take care of. Suddenly, the children that were dressed, fed, and bathed by a parent are now the ones doing the dressing, feeding and bathing, and that can be a tough thing for people to emotionally deal with. On the part of the children, there is often a huge disruption in their own lives and routines for work, school and activities for their kids, and other socializations that had been set for some time.
There is no doubt that this arrangement also has a lot of benefits, not the least of which is that the family is together during a time of difficulty and they can gain much emotional support from each other. And the cost savings compared to some of the other options is also a great benefit to the family. In some cases, moving in with the family has also been combined with the companion care option so that while family members are providing a lot of the needed care, there is someone else coming in to help with some of the activities that the parent would prefer to delegate to a non-family member, or, in some cases, cannot be done by a family member.
In my own grandmother’s case, she had moved in with my aunt because she could not live alone anymore, but it reached a point when neither my aunt nor either of her two young sons could lift her from bed to a chair or from a chair to a walker without great difficulty.
Part of the conversation also has to be the potential for “shifting income” in the form of rent or paying family members for help with activities of daily living. Most families are not thinking about being compensated, and in fact are thinking about providing care out of love. But the moving of income from the veteran, spouse, or widow or widower can be an important consideration when trying to qualify for the Aid and Attendance Pension Benefit.
Option 3—Assisted Living: Assisted living arrangements can range from simply living independently in a more communal environment where prepared meals and dining facilities are available along with organized activities all the way to needing some help with everything short of skilled nursing care. In many cases, assisted living facilities provide the whole range of assistance as needed so there is no requirement that someone needing more help has to move out of the facility until it is time for more skilled medical care and assistance than they can provide.
Assisted living is often less expensive than nursing care, but it is still more expensive than independent living and certainly more expensive than moving in with family. However, there is definitely more that can be done for veterans, their spouse, or the widow or widower when it comes to assisted living care, but that could be an educational section all on its own.
Option 4—Nursing and Skilled Care: This is often called nursing home care, but the fact is that it really is more accurate to call it “skilled care” because it can be administered in a facility or at home. Many people needing this level of care would prefer to stay at home, and it can be more cost-effective to do so. (When it comes to Care Assistance Planning and having Medicaid or other programs help pay for some of the care, the government is equally willing to have the lower costs of in-home but skilled care since it is cheaper for the government.) In other cases, a facility that provides skilled care may be exactly what it needed, and so staying at home may not medically be the best option for you or the family.
In any event, this is the level of care that often frustrates families the most because, unless they are medical professionals, the care of their loved one is taken largely out of their hands. Again, dealing with the loss of control is difficult for the individual needing care as well as the family, and this is one of the reasons we use the Senior Veterans Council and their geriatric care manager for all of our VA Pension Benefit cases.
While most people come to us to help with the financial aspects of Care Assistance Planning, we have to start with what kind of care is required and preferred by our clients in order to achieve the best possible outcome. After all, saving money is and should be secondary to getting comfortable, competent, and appropriate care.
If you do have further questions, you can email them to my office or call me directly. Call my office at 919-518-8237 and ask for Jeff, but please mention you are calling in response to my V.A. Pension Benefit Planning e-mails. Thanks again and enjoy the information. The next section will be on ways to pay for long term care.
Jeffrey G. Marsocci
The Care Assistance Center, LLC
8406 Six Forks Road, Suite 102
Raleigh, NC 27615
Jeffrey G. Marsocci was born in Fort Worth, Texas but was raised in Lincoln, Rhode Island and graduated from Mount Saint Charles Academy High School. He graduated from Hofstra University with an undergraduate degree in Business, and two years later earned his law degree from the same school. He also earned a Certificate Degree in Non-Profit Management from Duke University in 2004, he was the Alumni of the Month for Hofstra University in June of 2013, and his firm was honored by the City of Raleigh with the 2011 Human Relations Business Award. Mr. Marsocci also became a Certified Medicaid Planner™ in 2014, a certification granted by the CMP™ Governing Board*, and he is an attorney accredited by the Veterans Administration to practice before the V.A. and its applicable administrative and legal tribunals.
In addition to working in his estate planning, estate administration, and Care Assistance Planning practice in Raleigh, NC since 1996, Mr. Marsocci is the author of numerous books including Estate Planning Basics, The Veteran’s Long Term Care Solution and other planning books found on Amazon.com. Mr. Marsocci frequently holds seminars for clients, financial advisors and other attorneys on topics related to the life and estate planning field as well as developing and presenting continuing legal education courses for attorneys and life insurance agents. Mr. Marsocci is a member of the North Carolina Bar Association, the Wake County Bar Association, and the National Italian American Bar Association. He and his wife Kathleen live in Raleigh, North Carolina and work with various charitable and non-profit groups including Kiwanis. Both are recipients of the President’s Call to Service Award through the Points of Light Foundation for completing more than 4,000 hours of service during their lifetimes.
*Certification is granted based upon a qualified candidate demonstrating a mastery of the skills and knowledge of the subject matter. To achieve certification, a CMP™ must meet certain education and/or experience requirements, show proficiency in Medicaid Planning through a thorough examination, and commit to adhere to the highest in professional standards. A CMP™ also subjects himself or herself to discipline by the CMP™ Governing Board. A Certified Medicaid Planner™ is not necessarily an attorney, so this designation is not governed or regulated by any state bar association.
Professional advice on how to access Medicaid and VA Benefits without giving up the house or assets using a trusted step-by-step process that literally walks you through a complex and bureaucratic system.
Get your free information packet “How a Little Known VA Benefit Can Provide Monthly Financial Support”
David Cole of the Senior Veterans Council and I have put together a useful packet of information along with my book “The Veteran’s Long Term Care Solution: The Truth Behind Long Term Care Planning for Veterans with the Aid and Attendance Pension Benefit” which includes:
- 20-minute DVD outlines how the benefit can provide financial assistance towards the cost of in-home care, Assisted Living, or possibly independent living facility costs.
- VA Aid and Attendance Benefit Rate Table
- How to access immediate funds while applying for government assistance
- Using a NOVA Professional Advocate to Pre-Plan Your VA Claims
- Special Industry Report: Medicaid Secrets Reveals: Learn proven strategies to save your home and protect your life savings from devastating nursing home costs
- The Promise to America by Lyndon B. Johnson
- National Care Planning Council
- Book by Jeffrey G. Marsocci – The Veteran’s Long Term Care Solution: The Truth Behind Long Term Care Planning for Veterans with the Aid and Attendance Pension Benefit
Disclaimer: The information contained in this email is provided “as is” with no warranties or guarantees. This information should not be considered as actual legal, tax or investment advice and you should always contact a certified accountant, tax professional, or attorney before making any financial decisions. While every attempt has been made to provide current and accurate information, neither the author nor the publisher can be held accountable for any errors or omissions. You agree that you are solely liable for any and all reliance, use, or action on this information.