What you need to know about Medicaid Eligibility

What You Need to Know About Medicaid Eligibility

By Kate McGahan

(Remember laws can vary from State to State and from year to year! Be sure to check with an informed attorney, geriatric care manager or Medicaid or other informed human service representative to see how Medicaid rules apply to your individual situation.)

There are strict guidelines for Medicaid eligibility and the rules vary from state to state. If your income, resources and expenses fall within the Medicaid guidelines, you will be eligible for Medicaid assistance. A very important aspect of the Medicaid process is the determination of your ongoing medical and health care expenses as they relate to your income level. After all, the reason you are applying for Medicaid is because your medical expenses outweigh your ability to pay for them.

You will need to verify the extent of your medical expenses as well as account for your income and assets. If your income is too high, you may be eligible if your medical bills, when subtracted from your income, bring you below the eligibility levels needed to qualify. The process of subtracting your medical bills from your income to become eligible for Medicaid is called a "spend down".

If you have excess resources, you must also "spend down" to qualify for Medicaid. Usually assets include anything that can be converted to cash such as real estate, automobiles, IRAs, stocks, bonds, and bank checking and savings accounts. If your countable resources are over allowable limits, you can spend them down to the required level and then become eligible for Medicaid. You can reduce your cash resources by paying off the mortgage, buying a new car, making home improvements, prepaying taxes and utilities, or paying family members to provide you with home care and other services. This is a good time to prepay your burial expenses in the form of an Irrevocable Trust Agreement. You might also cash in a savings account and pay off the mortgage or to make a home improvement. Always keep a complete record of disbursements; Medicaid may ask you to prove how you spent it.

If you need Medicaid assistance and you reside in your home or apartment, Medicaid will set up a budget for you based on your income and medical expenses. There are laws that protect you so that you should always be able to live within the budget that is designed for you. If your income is greater than Medicaid allows you to have to qualify, you can "spend down" your excess income on your medical care needs to "buy in" to the Medicaid program.

If you require care in a nursing home or residential care facility, Medicaid will set up a budget for you that will indicate the amount of your monthly income which will go towards paying your cost of care at the facility. Medicaid makes allowances for you to keep enough of your income to continue to pay your health insurance premiums and provide you with a monthly personal allowance for special expenses such as cable TV, hairdresser services and the newspaper. The remainder of your income is paid to the facility towards the monthly bill. Medicaid is then billed for the rest of your cost of care. Under certain circumstances, you may be able to keep your home as well as a home maintenance allowance if your doctor believes that you will be able to return home within 6 months. This means that Medicaid will allow you to continue to pay your home maintenance costs during your stay at the facility.

Many people are afraid that they will lose their home in the Medicaid process. Your home can be protected for you so long as you reside there or have the potential to return there after a period of rehabilitation in a residential care facility. If your spouse, minor, blind or disabled child is living in the home or if an adult child, sibling or other relative was living with you for an extended period prior to application for Medicaid and has established residency at that address, your home may also be exempt from consideration.

Your spouse is the only person whose income and assets are deemed to be available to you if you require long term care. For purposes of determining eligibility, your combined assets are totaled and then divided equally between you and your spouse.

Part of the Medicare Catastrophic Coverage Act of 1989 brought about the "spousal impoverishment rule" which protects the rights of your healthy spouse. The rule requires that the income and assets of the "at home spouse/community spouse" must be taken into account when determining the eligibility of the spouse applying for Medicaid. Your spouse can keep his or her own income and usually some portion of your income to go towards maintaining his or her standard of living. This amount is determined upon the state's limits and your spouse's needs.

Your spouse who remains at home can keep the home, car, personal belongings, half of the assets up to a set amount (usually around $75,000+). Your spouse has appeal rights if he or she believes that the resource allowance is so low it will cause a hardship. Some states have a "Spousal Refusal" law which gives your spouse the right to refuse to pay towards your cost of care.

If you have extensive health care needs, regardless of income, you may be eligible for what is known as a Medicaid waiver. This is a concept where certain regulations regarding income are waived to allow eligibility for Medicaid to take place to specifically cover those health care needs. Because the application process is a complicated one, it is a good idea to contact an attorney, geriatric care manager or agency adviser to help you with the process. Be sure to seek the advice of a professional familiar with Medicaid eligibility, the limitations of transfers and the right to retain income and assets. If there is a charge associated with the services and you have to spend down your resources to qualify, this is a smart way to do it. You may save a lot more in the process.

Boomers Need To Plan

By Kate McGahan MSW

They are called The Baby Boomers; The Sandwich Generation. They are the largest segment of our population and they were born between the years of 1946 and 1964. They have become the driving force of the marketplace and an issue of increasing magnitude for our society as a whole.

Greater longevity, lower mortality and diverse lifestyles are causing giant shifts in the demographics of our society. Some of us will spend as many years in retirement as we spent in our career. Some of us may spend as many years caring for our aging parents as we spent raising our children. Many of us will have the overwhelming task of caring for our children and our parents simultaneously.

Government has created new laws and has redefined the healthcare system in countless ways in an attempt to keep Social Security, Medicare, Medicaid and the taxpayers intact. Corporations now offer benefits such as Family Medical Leave and employee assistance programs which specifically address eldercare issues. Individually tailored work programs and pension plans offer increased flexibility to workers. More and more companies offer Long Term Care insurance as an employee benefit.

The year 2011 is the year the first born Baby Boomer will reach retirement age. Our government anticipates its approach, our employers are addressing the potential effects it will have on workers, and our communities are building the momentum to equip society with the programs that will help meet the needs of an aging population. Aging is inevitable. It is not something we like to think about, but loss or disability is certain to be an issue for each and every one of us. What have you done on a personal level to prepare for your aging and that of your family?

Creating and implementing a personal long term care plan is essential. It is not unlike creating and implementing a business plan. It has to do with identifying areas of need and weakness, creating a strategic action plan to meet those needs and deciding how to finance the whole operation. It is about hoping for the best and planning for the worst. People who see themselves as having an element of control always feel more secure and therefore are more resilient when changes take place. The primary purpose of the long term care plan is to ensure that an element of control always exists, no matter what happens. It is a planning tool as well as a communication tool.

Maslow's Hierarchy

There are six basic elderplanning areas that should be addressed in your long term care plan.
Medical: Preserving your health and wellness comes first and foremost. Be sure to have a trusted physician and a solid health insurance plan that meets your specific needs and preferences. Be accountable for learning and understanding the issues at hand so that you can take an active role in your own medical care.

Psychiatric: Have a plan for coping with the possibility of mental health issues such as clinical depression or substance abuse and addictions. Address competency and treatment issues and develop an awareness of support and treatment programs available to you. Take care of your ongoing emotional health as a preventive measure.

Physical: Be aware of options related to home safety, accessibility and residential and retirement living. Home safety is crucial to preserving ongoing independence. Accessibility experts can help to modify existing homes to accommodate disabilities. Creative residential options such as continuing care communities and special needs programs are regularly being developed to meet the needs of those who cannot or who choose not to stay home.

Legal & Financial: Legal and financial independence results from your ability to create a realistic plan related to your retirement goals and your preferences regarding medical treatment and long term care. This involves choreographing investments, your insurance portfolio, taxes, trusts, and your estate to work together to meet your projected retirement needs.

Social: This encompasses your hobbies, diversional pursuits and areas of passion and productivity. It is about connecting with others: family, friends, neighbors and community. It is about preserving individuality, complete with cultural and ethnic traditions. It is about learning and growing, no matter what age you happen to be.

Spiritual: This addresses the ongoing development of your understanding of what is important in life. This is the area where faith, hope and charity reside. It is where knowledge and forgiveness take place in the depths of your heart.

Involve a team of professionals to help you implement your long term care plan. This team should consist of a physician, an attorney, a financial planner and a geriatric care manager who can help you to pull the entire plan together. Your advisers will become an important part of the foundation that will help you to feel more secure and confident in facing the days and years ahead.


Managed Care Forces Growth

By Kate McGahan CSW

The absence of a national health policy seems to have created a black hole that has been filled with profit driven managed-care programs. While states such as California have been adapting to the managed-care concept for a number of years, New York is just beginning to feel the effects. Syracuse is a good example of community agencies working together to rise to the changes in demographics and in the industry.

The cost of running Medicare and Medicaid programs has been growing at nine percent per year. Experts say that, by the year 2030, Social Security, Medicare and Federal pensioner programs will exceed the federal government's revenues. The seemingly insurmountable task of trimming the budget seems to have come down to trimming the payments to the care providers. Massive state and federal cutbacks have severely affected hospital and health programs and the way they do business.

What does this mean to us? The managed care shift has had the tendency to refocus the healthcare industry toward business development and marketing efforts rather than customer service and patient care. The game has become "SURVIVAL". In the hierarchy of needs, physicians, hospitals, home care agencies, and other programs which rely on insurance to keep them alive have had to find a way to put food on their proverbial tables. This is a challenging task and makes it difficult to meet the more advanced qualitative needs of perfecting patient care.

Aggressive insurance procedures now affect providers on a multitude of levels. Insurance companies reward hospitals for treating patients with higher clinical needs. Medicare pays a certain rate for the treatment of a specific illness and the insurance companies follow suit. The more severe the illness, the higher the reimbursement. They also can refuse to pay for days a patient spends in the hospital on which a significant intervention did not take place. Subsequently, providers now find they need to perform surgery and diagnostic testing on weekends and after hours to promote reimbursement. This means paying additional staff for hard-to-fill time slots. It also includes paying additional staff to process the multitude of paperwork required for patient billing and reimbursement.

The "system" encourages the prompt discharge of less acute patients and begins a ripple effect that forces all parts of the healthcare delivery system to push a patient quickly toward the least restrictive, most cost-effective setting. This ripple effect causes nursing homes, rehab centers, home care agencies and others to need to be available off-hours and on weekends to do intake assessments, admissions, and crisis intervention. This new system presents an arena of discharge planning and case management considerations.

Because nursing home and rehab facilities are reimbursed for patients with higher needs, they also are eager to discharge residents who are more able to manage in a less-restrictive setting. People who one would have been permanent residents in nursing homes are now being encouraged to return home with services or to go to assisted living programs and special care facilities. The system has been forced to be creatively revised in the face of these new regulations. New residential and home care programs have arisen to compensate for the greater number of nursing home and hospital discharges. Some skilled facilities have developed subacute and short term rehabilitative services to capitalize on higher reimbursement levels. More and more independent living programs are offering a concierge of services.

Alzheimer's Disease is tragically one of the lowest reimbursable illnesses. It is one of the most common, of the longest duration, the most time consuming, and exhibits some of the most frequent repeated use of services in the system. The system does not financially reward providers for caring for people with such disorders.

How we cling to the status quo! Peter G. Peterson, in his book Gray Dawn, gives us a reality check: By 2015, most developed countries will have more elders as a share of their population than the state of Florida today. Caring successfully for older adults in the face of managed care will take a community-wide effort. The population is aging and managed care is here to stay.

Healthcare providers need to develop a positive attitude despite the lack of perfection in the system. This means making a shift from a sickness mentality to a wellness mentality; to prevention vs. cure. It's about having vision and defining a contributing role within a system that thrives on networking. It's about being proactive rather than being swept along with the tide of managed care; to begin to create and enhance programs, products and services and to become leaders in a system specialty.

Many US hospitals are forming partnerships with residential and rehab programs, home-care agencies, and primary care providers. Residential facilities are developing day programs and menus of services to expand their markets. Doctors are joining forces to meet the comprehensive needs of their patients.

There are many ways to partner - formally and informally- to meet the needs within the senior healthcare system. Formal alliances allow partners to share operating costs and collectively to meet the needs of the community. Clinical, financial, social, private, and public programs need to be available, accessible, and mutually beneficial to the older population. We need to learn how best to utilize one another to support the needs of those who need us.

Learn to see this as a challenge rather than as a problem. Exciting innovations are already occurring within the Central New York system. Follow the leaders of the community in developing unique programs to offset the negative consequences of managed care.

Loretto and St. Joseph's Hospital have partnered to meet specific needs which make programs like PACE/Independent Living Services- a program designed to prevent/reduce institutionalization and subsequent costs possible. Crouse Hospital and Community General Hospital together created The Alliance, which proposes to merge with VNA Systems to streamline the continuum of care for their patients. SUNY Health Science Center recently announced participation in WebMD - a full-service Web site for doctors and their patients --made possible by the combined efforts and funding or organizations such as DuPont, Microsoft, and CNN.

Competition is a driving force of the new system. Once we re-establish our equilibrium, we can allow competition to do what it does best: improve quality, reduce costs, and encourage providers to be creative in the marketing and delivery of their services. We must also work collectively to keep the continuum of care smooth and as user-friendly as possible.

The possibilities are endless. Growth doesn't just "happen" without people making a conscious change. If we don't promote change on our own, life will inevitably do it for us. It has pushed us to grow in challenging, sometimes frustrating and very exciting ways.

Be ProActive Not Reactive

Be Proactive, Not Reactive in Caring for Aging Parents
By Kate McGahan LMSW

We don’t like to think about aging and the potential issues of death, disability, dependence and cognitive loss. Because we don’t like to think about these things, we tend not to plan ahead for the inevitable.

Yes, the “system” has it’s own frailties. The “system”, however, is making dramatic strides to try to improve service delivery while at the same time, to reduce the tremendous costs of running federal and state programs such as Medicare and Medicaid.

The Managed Care system is changing health care delivery by attempting to reduce and eliminate unnecessary costs and treatments of medical health care. While far from perfect, this has in part caused a dramatic shift in the care and lengths of stay in hospitals, rehabilitation facilities, and nursing homes. Hospital stays have shortened, rehabilitation while nursing home facilities are now meeting more acute care needs of their residents. The newer residential concept of “Assisted Living” is now meeting the needs of many people who normally would have required nursing home care. Home care programs have been recharged to meet increasing needs of those who wish to remain at home.

Granted, there are many weaknesses in the system. Therefore, we need to be accountable for planning for our own future and the future of our aging families. Never underestimate the power of the “private pay dollar” when it comes to buying what you need and want in the health care system. That “dollar” buys your choice of caregivers, physicians, residential options and other preferred services.

How do you maximize the private pay dollar? By starting as early as you can to plan for your retirement. By saving and investing your money wisely. By maximizing your retirement income and pension plan. Have a solid health insurance plan that best supplements Medicare and a Long Term Care(LTC) Insurance plan that will fill the remaining “gap” of financing your long term care needs in the future.

Find out about medically-deductible expenses which can include the costs of nursing home care, home care, medications, home improvements due to a disability, insurance payments, copayments and a portion of your LTC insurance premium. You may qualify for a dependent-care credit if you are caring for a dependent parent at home and if you contribute to your parent’s medical expenses, those expenses may be deductible if you itemize.

Investigate the possibility of creative options such as a Reverse Mortgage or a HUD conversion loan which allow you to use the equity in your home to fund the costs of your long term care. Open a Medical Savings Account (implemented in 1996 on a demonstration basis) which allows you to invest your money and then reap your earnings tax free if applied to your personal health expenses. Look at your life insurance portfolio; you may want to borrow from your insurance to pay for your current needs.

Respectfully encourage your parents to plan for the future, if they haven’t already done so. Think about and implement Advance Directives such as a Living Will or Health Care Proxy. Establish a Power of Attorney and a legal and financial plan to attend to future needs.

Involve a team of objective, competent professionals to help you design a plan that is best-suited to your situation and personal goals. The ideal team will consist of an attorney, a financial adviser, an accountant, an insurance specialist and a geriatric care manager. The involvement of this team will help you in making sound decisions in the areas of financial, tax, estate planning and personal long term care planning.

Many Baby Boomers will find that they will spend more years caring for their aging parents than they did raising their children. Some will find themselves in the overwhelming situation of caring for both at the same time! Only 5-7% of our elderly population resides in nursing homes. The others are being cared for by families, home care agencies and informal caregivers. Many more are living active, independent lifestyles.

Gather your team of advisers, save and invest your money wisely and learn what choices are available to you. Communicate with your family and create a healthy lifestyle for yourself. When you have the support of those who love you and the advantage of good physical, emotional and financial health, you will find yourself surrounded with unlimited choices as you face the days ahead.

Counting Our Blessings

Many of us get preoccupied with the things we have lost over the years. How important it is to also remember the things we still possess. This is the text from an email attachment I received that reminds us how fortunate we are:

If you woke up this morning with more health than illness, you are more blessed than the million who will not survive this week.

If you have never experienced the danger of battle, the loneliness of imprisonment, the agony of torture, or the pangs of starvation, you are ahead of 500 million people in the world.

If you can attend a church meeting without fear of harassment, arrest, torture, or death, you are more blessed than three billion people in the world.

If you have food in the refrigerator, clothes on your back, a roof overhead and a place to sleep, you are richer than 75% of this world.

If you have money in the bank, in your wallet, and spare change in a dish someplace, you are among the top 8% of the worlds wealthy.

If your parents are still alive and still married, you are very rare, even in the United States.

If you hold up your head with a smile on your face and are truly thankful, you are blessed because the majority can, but most do not.

If you can hold someone’s hand, hug or even touch them on the shoulder, you are blessed because you can offer healing touch.

If you can read this message, you just received a double blessing and you are more blessed than over 2 billion people in the world who cannot read at all.

Be sure to count your blessings as Spring arrives!

As we count our blessings, we thank the friends of Elderplanning who offer their ongoing support, confidence and assistance in helping those who need us to find us! The strength of our service is in the strength of the vast network of professionals and agencies in our health care community. We appreciate your referrals and your help in meeting the ever-changing long term needs of our local seniors and their families.

What You Can Do For A Loved One In A Hospital or Nursing Home

Here are a few ideas for brightening a day for someone who is confined or infirmed:
(From Nancy Keene/Rachel Prentice)
1) Send balloon bouquets*, funny cards, posters or humorous books. A cheerful hospital room really boosts spirits.
2) Send funny videotapes or come with a good joke. Laughter is a balm for the mind and the spirit and the body.
3) Bring puzzles, games, books, CDs, tapes or crafts.
4) Bring a basket of snacks or juices or favorite treats.
5) Offer to give visiting family a break from the room -- a walk outside, shopping trip, haircut or just some time for respite can be very refreshing.
6) Donate frequent flyer miles to out of town family member who have the time, but not the money, to help.

Sometimes in our work with seniors, the very fact that the family members are struggling and having a hard time with transitions and situations makes it even harder for the senior going through it. If you relax a little, so will the one going through it. Breathe! Try to put a smile on your face; it will help them and it will help you. ~Kate
*Also, did you know? If someone you love has a breathing problem or is on oxygen, it is the loving thing to do NOT to bring bouquets of fresh flowers. The decaying stems in the water emit toxins into the surrounding air that can be hazardous to someone who is medically compromised. Take a living plant or a balloon bouquet and leave the flowers in the garden!

Long Term Care Insurance: Tax Advantages


For Individuals...

~ Qualified LTC insurance premiums can be treated and itemized as medical deductions provided they exceed 7.5% of adjusted gross income.

~ Qualified LTC plan benefits received are not taxable income.
For Employers...

~ Employer - paid LTC premiums are treated like regular health insurance and are tax deductible for S- and C-Corporations.

~ Employers receive a tax deduction for any portion of LTC premiums paid for employees.

~ Employer contributions and paid benefits are excluded from employees’ income.

~ There are group rates available; medical requirements may be waived for employee-group plans.

Long Term Care Insurance: You Get What You Pay For By Kate McGahan LMSW

Don and his father sat in the office drawing up a plan of care that would address Don’s mother’s increasing needs. It was an emotional meeting because Dad had always taken care of Mom in their fifty-two years together. It was very hard to consider entrusting her care to someone else.

In a world where spouses can literally die taking care of each other, one short term planning goal was to find reliable professional caregivers to keep her at home as long as possible. They also needed to outline a long term care plan for when Mom could no longer remain safely at home. Mom had Alzheimer’s Disease, a progressively debilitating, cognitive disease which eventually robs its victims of memory and renders them unable to care for their most basic needs.

Together we outlined a menagerie of short term services that included home modifications, private duty and licensed caregivers, day care services and respite care. She remained at home safely for several years at which point she moved to a special care residence for the memory impaired and eventually on to a preferred nursing home. While these changes and transitions were painful for her family, the costs of her care could have been equally painful.

Fortunately, Don was a financial planner who had the foresight to sell his parents Long Term Care (LTC) Insurance prior to his mother’s diagnosis. That policy eventually would pay for every service rendered, including the cost of home modifications and the actual care planning process. She continues to live at a nominal fee, in the nursing home, thanks to her son’s proactivity. This family was lucky. They worked with someone who had their best interests at heart. The professional son knew his product and he knew how to choreograph it to be of the greatest benefit to them.

Not everyone is so fortunate. Take the elderly couple who took out a LTC policy in their 80’s – to the tune of nearly $9000 per year. They had done some planning already by setting up a trust ten years before to protect their assets. They had $30,000 per year in income and $6000 in personal savings. With nursing home rates in Central New York at $200+ per day, where would they come up with the additional $120 to co-pay the daily cost of the nursing home when the need arose? Answer. They wouldn’t. They would, however, pay that $9000 combined premium every year until one of them needed care, at which point they will apply for and be eligible for Medicaid. They were throwing their money away on premiums.

Then there’s the woman who had complete care of her husband with Parkinson’s Disease. She and her husband had purchased a LTC policy ten years before and it was now time to file the claim. As the situation progressed, the issue of Medicaid was addressed. They had purchased two “Partnership” Policies, LTC insurance plans specially designed to “partner” with the State of New York to provide Medicaid benefits once the claim period is exhausted (The strength of such a policy lies in the guarantee of the protection of assets, regardless of the amount of the client’s net worth at the time of the Medicaid application). When asked about Medicaid planning, she indignantly replied “WE’RE not EVER going on Medicaid”. This woman had no idea why she had purchased such a policy which would not benefit her in the ways in which it was designed.

Countless people have also purchased policies that “aren’t worth the paper they’re written on”. Many people are scared off by high annual premiums and they compromise on features to lower those premiums. Some insurance salespeople “undersell” to make the product affordable. Recently a middle aged couple were considering a policy that would pay them $80 per day for two years with a very high deductible and a simple inflation factor figured into it. They were willing to pay out $200 per month for the policy without considering the following factors:

-The average stay in a nursing home is 2.5 years

-The current costs per day are pushing $300. 24 hour home care can cost even more.

-When they retire and are on a fixed income, will they be able to come up with the $120 per day co-payment when it comes time to file a claim?

-When they are retired or on a fixed income, will they be able to continue to keep up with the cost of the premiums?

Many people have paid into insurance plans for years and eventually cancelled them because they could no longer afford them. Don’t take a plan out to begin with, if you suspect it may one day be out of reach.

Everything is a gamble, especially in the insurance industry, which is ruled by statistics. The son of an elderly woman inquired as to the cost of LTC insurance for his mother. She was nearly 80 years old and the costs were staggering. A policy that would meet her needs was nearly $8000 per year. He and his mother chose to invest in it. That was last April. Earlier this year she suffered a few setbacks and in March moved into a residential care facility at a cost of $40,000 per year. One more year of premiums (her "deductible") and her insurance company will take care of her for the next five years. The gamble worked in this woman’s favor.

LTC insurance isn’t for everyone. Be sure when you meet with an agent that they are reputable and have a sound understanding of long term care. Many of the people who sell ineffective policies are not dishonorable people. They have often been trained in products and annuities and investments, but they may not know anything about long term care. Be sure they have a solid understanding about care and service features. Ask them if they know about Medicaid and rules of eligibility. Know what you are paying for and remember that if it seems too good to be true, it probably is.

You may find yourself with a representative from one company offering you quotes including various plan features. Just like anything else, different companies offer similar products at different prices. Comparison shop for quotes from a variety of companies. The savings could mean thousands of dollars in the long run. Be sure to also work with a solid company that will still be around when it’s time to file your claim.

LTC insurance is the only way to fund the costs of long term custodial care. The right LTC insurance plan can protect you from the catastrophic costs of nursing home and other types of care. Have an expert review your current policy to be sure it is designed to meet your needs. Make an informed decision before buying a policy; it may be one of the most important investments you ever make.

How To Create A Business Mentality in a Service Business By Kate McGahan

For the Professionals In the Midst!
Reprinted From GCM Magazine

[For those of us in business there was a point where we made the decision to stop working for someone else. Some of us moved up the ladder to become CEO's and Administrators; some of us went off on our own to become independent consultants and business owners. Whatever route we have taken, we find ourselves immersed in the lives of people who need our services and/or products.]

After 15 years in the long term health care system, I founded a private geriatric care management firm. Leaving the comfort and security of 9 to 5, I was off to explore horizons whose vastness I couldn't comprehend at the time.

Now, two years after filing my DBA, I am more aware, more assertive and more involved in the community than I ever thought possible. Designing and implementing my care management practice has been my greatest and most rewarding learning experience yet.

All of us are somewhere along this continuum of learning. If we are just beginning, we have the excitement and fear of wondering "What's ahead?". If we're established, we can look back and see that this career that we have embraced has helped us to grow in ways we never imagined.

Most of us possess a human service mentality. That mentality can get in the way of running a successful business. Developing a business mentality is just as important in the service professions as it is in any other endeavor. Set limits. Establish priorities. Say "no" once in awhile. You can't be everything to everyone. Develop and maintain a business mentality and you will be a more effective service professional. You can do this in the following ways:

1) Immerse yourself in programs, books and magazines that will feed that mentality. Read magazines such as Fortune, Success and Entrepreneur. Subscribe to FORTUNE Magazine and your local business journals. If you incorporate these motivational materials into your life, you will internalize them and they will become a natural part of who you are.

2) Surround yourself with successful, ethical, growth-oriented people. They will provide you with role models and increase your expectations of yourself as you create your future.

3) Find a mentor -- someone who will objectively give you feedback, guidance and constructive criticism. There are no qualifications for this person except to be honest and forthright with the desire to see you succeed. Sometimes a mentor who is in a totally unrelated profession can be most helpful and objective. Look for chemistry and mutual respect in this relationship.

4) Regularly Update Your Business Plan. Set realistic goals for yourself related to your business and how you will accomplish those goals. Focus not just on a mission statement but on how you plan to meet your budget based on your earnings and how you plan to market your services. Measure client satisfaction and offer continually improved customer service based on this feedback.

5) Be organized! Have a good filing system. Don't waste time looking for phone numbers or sorting through piles of paper to locate something specific. Pay someone their hourly rate if you need help getting out from under the paperwork. It's amazing how much more organized your whole life will seem when your office in order.

6) Throw out the answering machine and get yourself an answering service. This improves your professional image and makes it easy for potential clients to feel welcome. If you shop around, you should be able to find a service that is friendly and reliable.

7) Hire a good accountant and seek other professionals when needed. Don't scrimp on financial or legal help. These professionals are all part of a healthy plan for your business to succeed and grow. Remember to plan for your own financial future. Don't lose this priority by your tendency to take care of others first!

8) Make yourself VISIBLE! Good marketing is the #1 reason businesses succeed. Much of this is done by becoming "known"; your person, your company, your logo, your name. Do this by public speaking and networking. Get your name in print by writing articles, press releases, even letters to the editor. Remind everyone as often as you can that you exist!

9) Network like a fanatic! There is no better business builder than being active in the community. Continually expand your referral base and nurture your best referral sources.

10) Have the discipline to balance work, play and family. Take time for physical activity and spiritual fulfillment. Balance is the key to lifelong success. Take care of yourself at least as well as you take care of your clients.

Most of us are in our preferred business for the same reason. We want to make a difference by creating a product or service that helps others. If we become successful by doing so, that's wonderful. If we become financially independent by doing so, that's wonderful too!

Many people will want to try to tell us how to run our business. The day will come when each one of us will realize that our profession isn't about running a business. It's about having a mission. That is the day we will find security in the knowledge that if we keep our heart in the right place, we will be given the tools to succeed. This is called leverage and puts us in the most enviable position of all.

Resident Rights: Part II

Psychologist Sol Gordon brainstormed a list of qualities a person possessed who also possessed self-esteem. They are as follows:

A sense of humor

Doesn’t exploit others

Has energy

Knows how to listen


Sensitivity to others needs

Tolerance to others changing moods

Learns to live with what they can’t change

Has enthusiasm

Exudes self confidence

Is capable of loving unselfishly

Knows when to take risks

Doesn’t insult others

Doesn’t pretend to have all the answers

Is optimistic

Is helpful

Capable of loving unselfishly

Appreciates the success of friends without feeling competitive

Is sympathetic to others

Is pleased to spend time with loved ones but doesn’t feel abandoned when that is not possible.

Again, Think back for a moment to those faces and personalities who touched you in this way. What comes to mind as you are asked to describe them? What unique qualities does that person possess?' Thus it stands to reason. If we provide each other with the tools to build self-esteem rather than to tear it down, we will be surrounded by people who energize us and who bless us simply by being healthy, responsive people.

A few final thoughts, a medley if you will, of quotes gathered from Thoreau, Leo Buscaglia, Arthur Peterson and Eleanor Roosevelt; all who have lived life to the fullest in their unique ways:

“Let the world be better for your having lived it.
Let those you meet day by day feel and know they are better for meeting and knowing and being with you.
Keep loving if you would keep young.
...To be sure, there are numerous stages of unfoldment, of development, but use what you know to do and you will be given the next step..
Those who seek to know themselves may find the way
And though the way be hard,
Those who find it become content and find
Joy, peace and happiness....

The purpose of life, after all, is to live it,
to taste experience to the utmost.
To reach out eagerly and without fear
For new and richer experience.

Oh God, to have reached the point of death
Only to find you had never lived at all!

No one will ever get out of this world alive.
Resolve, therefore, to maintain a sense of values.
Resolve to be cheerful and helpful and
People will respond in kind.
Resolve to listen more and talk less
No one ever learned anything by talking.

Resolve to be tender with the young
Compassionate with the aging
Sympathetic towards the striving and
Tolerant of the weak and the wrong
Because some time in your life
You will have been all of these.

Accept and appreciate your unique self.
Value and appreciate your growth and discovery
And you will encourage others to do the same.
Live by taking advantage of all of your life-given rights,
Now and always.

Our contribution should be that of becoming all we can
become as a person and allowing each and every person that privilege. if we do this through love and caring and by being a nonjudgmental person, when we leave this place, as we all will,
it WILL be better because of our having been there.

How To Reduce Your Long Term Care Premiums

While long-term care insurance can be a great way to pay for a nursing home stay or a home health care worker, it doesn't come cheap. Annual premiums vary significantly, depending on your age, health, and the type of policy, but policies can run as high as $5,000 per year. In these challenging economic times, people have to make hard choices on their budget and priorities. Here are some ways to reduce your LTC Insurance costs if you need to take a serious look at your own:

Shorter benefit period. The most significant cost-saving step you can take is to not purchase a lifetime policy. Unless you have a family history of a chronic illness, you aren't likely to need coverage for more than five years. In fact a new study from the American Association of Long-term Care Insurance shows that a three-year benefit policy is sufficient for most people. According to the study of in-force long-term care policies, only 8 percent of people needed coverage for more than three years. By purchasing coverage for three, four, or five years instead of a lifetime, you can save thousands of dollars in premiums. If you do have a history of a chronic disease in your family, you may want to purchase coverage for 10 years, which would still be less than purchasing a lifetime policy.

Buy younger. Long-term care insurance premiums rise as you age, so the younger you buy, the cheaper your premiums. Be careful, however, because insurance premiums can, and often do, increase considerably from your initial purchase price. Even if you have a policy that is "guaranteed renewable," your premiums can still increase.

Shared care policy. If both you and your spouse are purchasing long-term care insurance, a shared care policy might be able to give you more coverage for less money. With a shared care policy, you buy a pool of benefits that you can split between you and your spouse. For example, if you buy a five-year policy, you will have a total of 10 years between you and your spouse. If your spouse uses two years of the policy, you will have eight years. A shared care policy may cost more than separate policies with the same benefit period, but it will allow you to buy a shorter policy, knowing that you have a pool of benefits to work with.

Longer elimination period. Most policies have a waiting period before coverage begins, typically 30-90 days. The longer you make this waiting period, the cheaper your premiums. Keep in mind, however, that you will have to pay for your care out of pocket until the waiting period is over and the insurance begins its coverage.

Reduce the daily benefit. Instead of purchasing the maximum daily benefit you might need in a nursing home, you can consider paying for a portion of the daily benefit yourself. You can then insure for the maximum daily benefit minus the amount you plan to pay. A lower daily benefit will mean lower premiums.

Inflation protection. Inflation protection increases the value of your benefit to keep up with inflation and is almost always recommended. But you can save on premiums by which method of protection you choose: compound-interest increases or simple-interest increases. If you are purchasing a long-term care policy and are younger than age 62 or 63, you will need to purchase compound inflation protection. This can, however, more than double your premium. If you purchase a policy after age 62 or 63, some experts believe that simple inflation increases should be enough, and you will save on premium costs.

You should also remember that your premiums may be tax-deductible. Premiums for "qualified" long-term care policies will be treated as a medical expense and will be deductible to the extent that they, along with other unreimbursed medical expenses (including "Medigap" insurance premiums), exceed 7.5 percent of the insured's adjusted gross income.

Did You Know?

Caregiver Statistics
"There are 22 million family caregivers to the elderly in the US. The majority of them are also employed full-time. 5% of them have taken an unpaid leave of absence; 50% have lost time out of work to fulfill their responsibilities." -National Caregiving Association

Safe Return Program

Safe Return

Changes in fee structure for the Safe Return program, effective September 1, 2006. I would appreciate it if you could take the time to read this and pass on the information to both colleagues and families affected by the program:

Enrollment Fee: The fee for the enrollment of the person with dementia remains $40.

Annual Fee: This is new. The annual fee is $20. The Alzheimer's Association (at the national, not local chapter level)will mail out a bill to enrollees annually beginning September 1, 2007. Important: Individuals who enrolled in Safe Return prior to September 1, 2006 will be grandfathered into the system and will NOT be charged an annual fee.

Caregiver Jewelry: Caregiver jewelry will cost $15 rather than $5. Please continue to encourage caregivers to purchase the jewelry, as this is an important feature of the program.

Financial Assistance/Scholarships: Scholarships for enrollment in Safe Return are still available through the chapter. We can provide scholarships for caregiver jewelry, but we will not be providing scholarships for the annual fee. Be aware that National has made it clear that no one will be turned away from the program if they cannot afford it.

For those of you who are assisting people with the completion of the applications:

--Please make sure that the enrollment form has been signed by the primary contact. National will not process these without a signature, and a missing signature causes a delay in the enrollment process.

--Please make sure to completely spell out information (i.e. county name, city, etc.). No abbreviations, please.

--A diagnosis of dementia or AD must be written on the enrollment form under "Diagnosis."

--Please encourage families to send in a picture of the person with dementia. If they do not have a picture with them at the time of application, they can always mail in the picture separately with the person's name, date-of-birth and social security number on the back.

Thank you for taking the time to become familiar with these changes. If you have any questions, please contact me.


Gwen Minton, MSW

Helpline & Education Coordinator

Alzheimer's Association, Central New York Chapter

441 W. Kirkpatrick Street, Syracuse, NY 13204

315-472-4201 Phone

315-472-4206 Fax

800-272-3900 24/7 Helpline


Website: www.alzcny.org

Welcome Message From Kate

Greetings and welcome to the first entry in our elderplanning blog! The purpose of this site is to post up-to-date information on eldercare and elderplanning so that you can have the information you need at your fingertips when you need it. This blog will also allow us to process information directly rather than pestering our webhost who takes care of our Elderplanning website. Of course we just set up this account this evening and wish that we could have everything on display for you pronto - but it will take time. But we are going to do our best to cover lots of bases here --- medical, emotional, financial and otherwise, so please come back again! We've been in business over a decade and I've personally been in the industry for 25 years --- it will take some time to document here what's in my head. But I'll try -- and I'll do it on a regular basis too. So please stay tuned..... Of course if you can't wait and have an issue that is pressing NOW, don't hesitate to contact our office. Please visit our website for contact information.