Elder Law is a legal discipline that addresses the needs of aging seniors as well as individuals with disabilities. Our elder law services blend Estate Planning with a focus on long-term care planning and advocacy. We believe that estate planning is not just about what happens after you die but needs to address how you will live as you age. Long-term care planning must address health care needs, family dynamics, personal values and the resources available. We address the financial burden of the cost of care by advocating for and maximizing our clients’ eligibility for government benefits, including Medicare, Medicaid and Veterans’ benefits. Our firm goes beyond traditional planning to guide our clients in locating appropriate care, coordinating private and public resources to finance care, and advocating for their rights.
Areas in which WanderPolo & Siegel assists clients include:
Long-term care planning is the comprehensive process of helping clients and their families prepare for challenges that may arise from aging, illness and disability. Our staff assesses current finances and health care needs, and develops a plan to address the likely needs a client will have during their long term care journey. This plan is centered on asset preservation and planning for long-term health needs. We preserve assets through identifying and planning for third-party payer sources, ensuring the correct level of care and the transfer of assets. We prepare for future care needs by outlining issues that are clients currently face and our Care Coordinator provides insight into disease progression and potential challenges that our clients may face down the road. We consult with clients regarding options for long-term care, advise them on placement options, funding sources and services available through government and private agencies. We also review admission agreements to ensure that residents and family members are protected.
We offer Life Care Planning to forge a long-term relationship between our firm and our clients to offer continued guidance, advocacy and support as changes occur in health, finances, and lifestyle.
Many clients wait until they need nursing home care before consulting an elder law attorney. However the delay can be costly. Pre-crisis planning has many advantages:
- It helps you get the care you need today.
- It increases the chances you can age in place, preserving independence.
- It often provides more opportunity for asset protection.
- It ensures you don’t make innocent mistakes that can result in Medicaid ineligibility.
- It provides you and your family with a network of support to help you prepare for and deal with transitions and crises as they occur.
Veterans are recognized for their service with a host of public benefits. Unfortunately, most are not aware of all of the benefits they are eligible to receive. We assist clients in applying for benefits that cover the cost of care in an assisted living facility or at home. We also educate clients about other veterans’ benefits such as the State Veterans Memorial Homes and respite home care.
This includes the application for a Veterans Pension, which is a disability income program available to veterans or their single surviving spouse. In order to be eligible for this pension, there are certain medical, asset and income requirements that need to be met:
- The veteran must have served at least 90 days of consecutive active duty service, one day of which must have been during a war-time period.
- The veteran must have received a discharge that was other than dishonorable.
- The claimant must have limited income and assets available.
- The claimant must have a permanent and total disability or be over age 65 at the time of the application.
- The disability was caused without willful misconduct of the claimant.
- The veteran or widow provides a signed application to the VA.
The high cost of medical expenses associated with long-term care is usually what qualifies a veteran for the pension. We can help you determine if you are eligible.
Many people confuse Medicare and Medicaid and most seniors assume that Medicare covers long term care costs. Unfortunately that is generally not the case.
Most individuals who have reached the age of 65 are eligible for Medicare coverage and there is automatic enrollment for Part A for those who are receiving Social Security at age 65. There are several parts to Medicare: Part A (hospitalization), Part B (major medical), Part C (HMOs) and Part D (pharmaceutical coverage).
Part A- Hospitalization
Part A is the basic Medicare hospital insurance. For most individuals there is no premium for this coverage. It covers inpatient care in hospitals, skilled nursing facilities, hospice and home health care. However, it only covers skilled care, not assistance with basic activities of daily living or supervision, known as custodial care. It is this custodial care that comprises the essence of long term care and is not covered by Medicare or other health insurance.
Advocacy for the patient is essential to maximize coverage under the Medicare program. For example, a common pitfall is where a patient’s rehabilitation stay is not authorized because their three day hospital stay was not considered an admission as the patient was merely on “observation status”. Another situation our clients commonly face is termination of rehabilitation coverage for “failure to progress” despite a recent class action lawsuit prohibiting such action.
We educate and advocate for our clients facing these and other Medicare coverage issues. We also provide advice on when seniors should enroll in Part B and choosing between traditional Medicare and Part C Advantage plans.
Many people are confused about which public benefits they are eligible to receive and how those benefits work. Medicaid may be one of these benefits and we are experienced at working with clients to navigate the Medicaid system.
Medicaid is a needs-based, means-tested program originally conceived as a way to provide health care for the poor. Over the years it has come to be a major payer of long-term care costs for the middle class.
Payment of long-term care costs is one of biggest medical expenses that anyone will ever pay. Many individuals find that they cannot afford to pay on their own and need to explore Medicaid. Without sound advice, seniors often make costly mistakes – either by taking actions which inadvertently result in penalties or delayed eligibility or by not preserving assets and maximizing income legally. We help our clients plan for and apply for Medicaid guiding them through the complex rules and policies so they get the benefits they need while protecting their families to the greatest extent possible.
New Jersey Medicaid has gone through dramatic change in the last couple of years. Until recently, Medicaid had an income cap for home care and assisted living eligibility of about $2,200 per month. However, over the last two years several programs were merged so that now there is effectively no income cap for those needing long term care. With the exception of certain exempt resources, assets in excess of $2,000 have to be spent or otherwise be unavailable at the time of application in order for an individual to be eligible for Medicaid. There are opportunities to preserve assets and maximize income for spouses and other family members, but it is dangerous for families to make their way through the minefields of Medicaid regulations, policies and caselaw without experienced and knowledgeable counsel.
We guide our clients through this complex process. Under Managed Long Term Support & Services (MLTSS), there is also a new medical screening. This is another important opportunity for advocacy as the screening determines eligibility as well as number of hours and services for applicants at home.
Unfortunately, sometimes clients do not seek counsel until it is too late to prepare estate and health planning documents. When issues of capacity arise, there may be no one able to access accounts or make medical decisions. In these cases, we assist clients in obtaining guardianships or conservatorships to address the healthcare decision-making and financial needs of their disabled loved ones.
Guardianship and conservatorship are obtained through petition in the Superior Court. With our extensive experience handling these matters, our firm can help you maneuver the legal system and help keep costs down.
One of the hardest things for our clients to talk about is planning for end-of-life care. This includes appointing agents to make decisions concerning healthcare and making decisions that express wishes regarding life-prolonging measures and treatment. We help individuals and families gain control of the dying process and maintain independence through the end of life.
The goals of care for a patient’s healthcare plan are an important part of the comprehensive understanding of the patient’s medical condition, expected prognosis and the patient’s specific goals such as wanting to spend time at home with family, wanting to get treatments that allow the patient to live until a loved one’s wedding or wanting to be comfortable and pain free regardless of length of life.
Since 2011, Practitioner Orders for Life-Sustaining Treatment (POLST) have become available in the state of New Jersey. POLST is an approach to improving end-of-life care in the United States, encouraging doctors to speak with patients and create specific medical orders to be honored by health care workers during a medical crisis. It is a standardized, portable, brightly colored single page form which is immediately recognizable and can be used by doctors/advanced practice nurses(APN) and first responders including paramedics, fire departments, police, emergency rooms, hospitals and nursing homes.
POLST is designed for seriously ill patients or those who are medically frail with limited life expectancy, regardless of their age. It was designed in response to seriously ill patients receiving medical treatments that were not consistent with their wishes. The goal of POLST is to provide a framework for healthcare professionals so they can provide the treatments patients do want and avoid those treatments that patients do not want.
The POLST form complements an Advance Directive and is not intended to replace that document; an Advance Directive may still be necessary to appoint a legal healthcare decision maker and is recommended for all adults, regardless of their health status. POLST is a set of medical orders that help give seriously ill or frail elderly patients more control over their end-of-life care.
POLST is signed by both the doctor or APN and the patient or their surrogate. Filling out a POLST form is entirely voluntary. However, New Jersey law requires that medical orders contained in a POLST be followed by healthcare professionals and provides immunity from civil or criminal liability to those who comply in good faith with the patient’s POLST.