Video Transcription
Hello, everybody, and welcome into senior living live. My name is Melissa. Thank you so much, as always, for being with us here today. We've got an awesome webinar today discussing the legal side of making that transition into senior living or assisted living. Jerold E. Rothkoff, you see him there, managing attorney at Rothkoff Law Group, will give, all of you today guidance on financial planning, care coordination, and, of course, legal advice to help ensure a really smooth transition into the next phase of your senior living journey. Of course, as with all of our webinars, but especially today, we really want you to take advantage of the Q & A option.
You could find that at the bottom of your screen. You'll see the q and a button. You could type that there.
Click on that. Type your questions out there, and I will be happy to read those to Jerold at the end of his conversation, presentation today. And, of course, as always, we want all of you to be a part of our conversation this afternoon. Jerold, it is fantastic to have you here today. We're so excited for this webinar. It is all yours. Take it away.
Thank you, Melissa. Thank you so much. Good afternoon.
Everyone, I guess, where you are in the country, so either good morning or good afternoon. My name is Jerry Rothkoff. You can call me I'm officially Jerold, but feel free to refer to me as Jerry, it's fine. I am the founder and managing attorney of an elder care law firm referred to as Rothkoff law group, where we work in throughout in Pennsylvania, New Jersey, more specifically, Eastern Pennsylvania, and South and Central New Jersey. And our focus is simply to help the older adults, those living with disabilities, and those who love them, their care partners get the best care possible in whatever setting is possible. And I thank Arbor Terrace, for inviting me today, to speak to you all. And as Melissa said, don't be shy. Feel free, to put questions that you may have in in the chat or the Q & A, portion of Zoom, and I would be happy to address them.
And so what I what I wanted to cover today is simply what to look for specifically when you when your loved one or yourself, be it a child I mean, it could be a child in some cases, but could be a parent, could be a spouse, could be a sibling, is transitioning out of the home typically to some type of long term care setting. And, obviously, with Arbor Terrace being an assisted living community, we will specifically refer, to assisted living, but we can talk about nursing home setting. We talk about independent living, whatever whatever you're interested in.
Just a little brief information regarding Rothkoff Law Group. As I mentioned, we are located in both, eastern Pennsylvania serving throughout the Philadelphia metro area and south and central New Jersey. And our focus is exclusively to work with older adults and those living with disabilities to address issues related to care.
And specifically, we're rather unique in the services that we provide in the sense that we provide traditional legal services for older adults and those living with disabilities, such as estate planning that can encompass trust planning, wills, powers of attorney, advanced directives.
We deal with more traditional elder law issues such as guardianships and dealing with issues related to incapacity as well as dealing with public benefit issues, be it veterans benefits, Medicaid, Medicare.
And as well as other issues related to older adults.
Such such as protecting assets from long term care expenses, insurance denials, etcetera.
That's all part and parcel of what we do.
However, the most important thing we do is health care advocacy.
More specifically, we have eight full time geriatric social workers who work full time in the office.
That's the most important staff we possibly can have because the focus is to get the best care and advocate for our clients. Many of our clients need care in the home or possibly out of the home. So our focus is to address issues related to Future housing, as well as keep the client safe in their home. In addition to our eight geriatric social workers who visit our clients in whatever setting that the client is in to get the best care possible and advocate for them.
We also have two death tools. We have two occupational therapists who do home safety evaluations and and rightsizing, so to speak, for our clients to determine what's the best place to live or make any, modifications.
Possibly to their physical surroundings that would be necessary in order to keep them in the least restrictive environment and help them and help them be more ex for accessibility in the home.
And, again, it's rather unique in the services offered.
We were work one of the first few firms to have geriatric social workers as part of our law practice, and we've had geriatric social workers in the office for over it's been eighteen years now, and we're always looking to add value.
I know some of you are in different parts of the country other than Pennsylvania or New Jersey. So I'm not gonna be able to answer any specific state information that you may have. I would refer you to a local elder law firm in your geographic area or state in which you or town in which you live. So but I'll be happy to try to address as much general information because some of the some of the the issues specifically surrounding Medicaid eligibility, for example, for an assisted living community is very much state specific.
Okay? So let's get started. And, Melissa, if anyone has any you don't have to wait to if anyone has any questions, there is no need to wait to the end to to throw out some questions to me. If you have a question midway through, would be happy to address it.
I probably saved at least ten minutes at the end, if not more, for some q and a. But if there's any questions during the presentation, I would be happy to address them as well. Okay?
Okay. That sounds great. And the only question we have, you just addressed in terms of the state specific advice. So, continue on. We are looking forward to it. Thank you.
Okay. I'll come back to some state specific advice. So and as I go, probably.
Alright? Okay. So let's start with this premise. Okay?
Let's start. And feel free in the chat to throw out who you think Who said this?
And maybe even more importantly, in what setting. So here's a quote by a famous American.
No longer will older Americans be denied the hearing miracle of modern medicine.
No longer will illness crush and destroy the savings they have so carefully put away over a lifetime so that they might enjoy dignity in their later years.
No longer were young families see their own incomes, their own hopes eaten away simply because they are carrying out their deep moral obligations to their parents and to their uncles and their aunts. And no longer would this nation, meaning the United States of America, refuse the hand of justice to those who have given a lifetime of service and wisdom and labor to the progress of this progressive Country.
Any thoughts about what famous American?
Said this quote.
And for bonus round In what setting?
Was it FDR? That's what someone wants to know.
You are you're certainly moving in the right direction, and I and I think that is a fantastic guess and answer.
However, it's a hundred percent incorrect. Oh.
But you're moving in the right direct. FDR, I get it. You're thinking the new deal.
This kinda sounds like a new deal type of quote back, you know, certainly after World War II, and you're moving in the right direction.
Just a, just just a little more modern than that.
Lyndon Baines Johnson said this.
And in what context? So you're I you're you're you're almost you were almost there.
So it was Lyndon Baines Johnson in 1965.
And and in what setting did he say it?
It was when Medicare and Medicaid became when he signed the Medicare and Medicaid Act into law in 1965.
Okay. So that is fifth.
What's that? Sixty years ago. Right? Does that sound right? Sixty years ago. Does that sound right according to my not very good math? Yes.
Okay. So Let's get the question that and this could be a rhetorical question, but the question I ask all of you Knowing that this was said sixty years ago, does LBJs quote when Medicare and Medicaid law became into effect. That was a big deal. You know? I mean, FDR was Social Security, which was a big deal. FDR signed the Social Security Act into effect in the thirties, And But Johnson signed Medicare and Medicaid law into effect. So which really hasn't changed very much over sixty years, I would argue.
So do you think his What he stated in nineteen sixty five, sixty years ago, still applies in year 2025 sitting here today?
Anyone?
It could be a rhetorical question. You don't have to answer that.
I would argue, at least from my perspective, and and I want you to understand my biasness coming into this. I am very biased when it comes to advocating for older adults.
I'm a card carrying advocate for older adults. So I am biased. Okay? I am not a neutral party here. I am not Switzerland. I will tell you that. So in my humble opinion, working with older adults for over twenty five years now, I would argue that probably this really does not currently.
Hold True. At least a hundred percent true today.
And you I mean, again, I this is not I'm not here to be political or get in any means of political conversation.
But we're still having the same debate today, sitting here today over the government shutdown, aren't we? Because regardless of which side of the aisle you may sit on or whether you sit right in the middle of the aisle, the fact of the matter is the government shutdown is over access to health care.
That's why this government is shut down as we see the federal government, of course, I'm talking about, is technically shut down as this webinar is occurring today, October 15, 2025. So and we still haven't gotten it right. We still haven't I would argue, we still haven't gotten it right.
It was a good start in 1965, but we have a hell of a way to go sixty years later, I would argue.
That, and we'll talk a little more about that, but we're still fighting, I would argue, over the same issues regarding access to health care.
Is health care a right?
Is it an entitlement?
Is everyone entitled to health care?
Should you have the have and have have nots when it comes to health care?
Those are important policy questions that this country is still grappling with, I would argue.
So Medicare and Medicaid have been huge.
or I should say, have been a significant value to many, many older adults to keep them out of poverty, access quality care.
However, things have changed over sixty years, but the laws really have not changed very much.
So we're gonna come back to that. And but and if you have any further questions or on that, feel free to share.
Melissa would be happy to share them with with all the attendees.
So that's it. Let's get into estate planning documents. So when we talk about estate planning documents - Regardless of - I'm starting with this because this these are the building blocks.
Regardless of the type of setting that you or your loved one is in, regardless of the medical status of your loved one, whether they're living at home and the goal is to stay at home, whether they're in independent living, assisted living, or nursing home, whether they're paying for care or not paying for care, whether they need care or do not need care, whether they're single, whether they're married, whether they everyone needs these basic documents. And as you age, it becomes even more important to have these documents because it's important to sign these documents when you are competent.
Of course, As you age, the chances of developing some type of cognitive impairment, like Alzheimer's related dementia increase as you become older. So with Everyone needs a will with or without tax planning, and the type of will you need is really dependent upon your specific situation. I'm not here to talk about, you know, what type of will you should have, should not have.
Meet with your own estate planning adviser, and they can advise you more specifically.
However A will is not really the most important document most people need.
A will is important. Don't get me wrong
But a will is important.
Really based upon your specific situation, but a will is only effective When? When a certain event occurs, and that of course is called death.
Prior to death, everyone who's over the age of eighteen, in other words, a legal adult needs to have documents for living. And those documents for living, on your state, are generally referred to as a durable financial or durable health care power of attorney. In some states, they may be referred to as a health care proxy. And, again, as to estate planning, each of the fifty states have their own laws. So I'm not here so it may be different in your individual states.
But regardless, each individual needs a durable financial and a durable healthcare power of attorney.
In other words, you want to appoint a third party, specifically a decision making surrogate, to assist you in making decisions, specifically if you become incapacitated at some point in time. When I say incapacity, I'm not necessarily talking about from a physical incapacity. I'm talking from a mental incapacity.
Generally, for some form of cognitive impairment.
You wanna sign documents when you are competent, and those documents would continue to be effective if at some point you are in you are incapacitated, incapable of making financial and health care decision, and you would point a third party surrogate. That could be A spouse. It could certainly be a child. It could be a good friend.
It could be a sibling. It could be a grandchild. It can it could be a niece or nephew. You want to appoint someone during your lifetime to make decisions if you become incapacitated
And, of course, as the older you get, there's a greater chance of of having some type of cognitive impairment in place.
Also, you would want a living will and advanced directive. Again, there's different terminology in each individual state, which in a, unlike a health care power of attorney, it's specifically designed for end of life situation. What care you want, what care you do not want.
Sometimes the health care power of attorney and advanced directive are combined into one document. Sometimes they're separate documents.
Also, there's from a trust perspective, you and depending on the state that you live in, maybe a revocable living trust would be appropriate. Maybe some form of an irrevocable trust is would be appropriate.
And, that you may need it. You may not need it. It really boils down to your state laws, some of which involve a state administration.
It may boil down to your own individual assets, the real estate you own, or any individual assets, whether you're a single individual or spouse or spouse and spouse, and also whether or not you need a irrevocable trust. You don't you may you may not need some type of trust whatsoever. It but those are the those are some of the basic documents you would need. In addition to the estate planning documents, there is, something referred to as a POLST. That is an acronym.
Based upon your state law, That refers to A Physician Order for Life Sustaining Treatment, POLST, POLST, Physicians Order for Life Sustaining Treatment. It may not be law in your jurisdiction. Okay?
It's law in Pennsylvania as well as New Jersey. But in your specific state, it may or may not be law. That is a physician's order where you would sit down with your individual physician, and you would decide whether or not to sign, a physician's order for life sustaining treatment that both yourself and the physician would review and then sign. And that would be an order about what type of care you want and what type of care you do not want.
Now this has nothing to do with transitioning out out of your home to an assisted living community necessarily, but it's documents that that that's kind of the building blocks. Not but not every state has these documents in place. So those are the basic documents that you would find in most states or, or, you know, that you would need at least. So if you have any questions on that, I would be happy to address it in the chat if there are any specific questions regarding those documents in place.
And if there are, feel free to Melissa can shout it out. But, otherwise, I'll move on to the importance of preplanning.
The average cost of nursing home care today, depending on the state, is most likely in excess of a hundred and fifty thousand dollars. For example, I I work in the Philadelphia metropolitan area, either in Pennsylvania or Southern New Jersey.
The average cost is over fifteen thousand dollars a month, a hundred and eighty thousand dollars. There are less expensive states where maybe it's closer to ten thousand. There are more expensive states like California or New York where it might be closer to twenty thousand out.
Care is very expensive. Now when we talk about assisted living depending on the location of the we will use Arbor Terrace, obviously. It could be over one hundred thousand dollars private pay. Now the main difference between nursing home and assisted living other than the cost I mean, assisted living, it might be eight to ten thousand dollars a month, but there's also different types of assisted living. There there's also what's known as memory care assisted living.
So memory care assisted living could could be in excess of ten thousand dollars a month, closer to twelve thousand. Again, it really depends upon the location of the community. There are states that the care is less expensive. There are states, like I said, like New Jersey, California, like like Pennsylvania, where the cost could exceed these numbers.
And but the main difference and this is important when you look at for for services for your loved one. The main difference between when you talk about reimbursement is how the care is reimbursed.
Other than the higher level of care, in a nursing home setting, there in addition to out of pocket costs where you pay privately, Medicare can cover a portion of the bill, but it's limited. It limited to not exceeding one hundred days total. So someone who's over sixty five or blind or disabled prior to age sixty five generally has Medicare coverage that can cover a short term rehabilitation stay in a nursing home, for example.
And then based if they're eligible for state Medicaid benefits They can receive Medicaid coverage typically after Medicare's Is Medicare days end or they qualify financially? I don't know. I'm not gonna spend a very much time talking about Medicaid because that's very state specific. And and what happens in Pennsylvania, New Jersey may not be what the laws are in Texas. So it's very state specific. I would refer you to out to your individual experts in those in the state in which you or your loved one resides in.
But one of the main differences is in a, assisted living setting, unlike a nursing home setting, there is no health insurance coverage that will cover assisted living costs.
Why? Because it's what cons is considered custodial care, meaning that it's not skilled care. So that means no Medicare coverage. There may be, if if someone is fortunate enough to have long term care insurance, that could cover the home care, or that could cover assisted living care, cover nursing home care. But your health insurance, mainly for our older adult clients, their Medicare coverage or their supplemental coverage will not cover assisted living costs.
Also, Medicaid is not as prevalent in a nursing home setting I'm sorry. In an assisted living setting, excuse me, as it is in a nursing home setting.
Some states, there is no Medicaid coverage whatsoever for assisted living.
In, for example, in Pennsylvania, there generally is no coverage under Medicaid for assisted living. New Jersey, there is, but even that is limited. Most communities have a minimum number of beds for Medicaid, and you have to pay a minimum number of months before you are potentially eligible even if you have no assets in your name. So assisted living, generally speaking, and, again, you have to look at your state individual state, tends to be private pay.
Also, the when we talk about the importance of preplanning, avoid the need for a guardianship. I talked about your documents that if your loved one is not capable of signing documents, you may need to go to a court in your jurisdiction and and apply for what is known as guardianship. In some clay cases, specifically California, it may be referred to as a conservatorship, but you would need to go to the the The county Court and ask for you or your loved one or someone else to be appointed a guardian for your loved one. So by having these necessary documents in place, you can access funds and avoid a potential guardianship, which is, expensive and time consuming. Also, you wanna investigate your housing options.
When it's a non crisis situation.
So for example, if your loved one is already diagnosed with Alzheimer's disease.
And the Alzheimer's, unfortunately, is progressing.
The goal is to stay at home. But at the same time, you wanna investigate what options are available for housing in your community. Maybe you're the a child and you live across the country, and you wanna look at an Arbor community in your area.
Well, you probably wanna visit that Arbor community, find out what the cost structure is gonna look like, what's the process, what do they need.
How do how about if they live across the country, they have to assess your loved one? How are they gonna do that?
Is it gonna be a virtual assessment? Are they gonna need medical records? So investigate the housing and care options.
What's their if assets are relatively limited, what's their Medicaid policy?
What happens if you run out of money?
Will you have to find another community for your loved one to live?
If there's if your loved one has long term care insurance Well, will the long term care policy cover assisted living care, That's all part of your due diligence and investigation.
Also, you wanna protect a healthy spouse. So if there is a healthy spouse who's still live going to live in the in the primary residence, well, does the residence need to be sold and the funds used to pay for care for that other spouse? What is the goal to stay? If the goal is to stay at home, do we protect that spouse to give that spouse additional assets and income?
Do they wanna move in together?
So in other words, Arbor Terrace is an excellent community. We have two Arbor Terrace communities within fifteen or twenty minutes of one of our offices in Southern New Jersey in outside of Cherry Hill, New Jersey.
But Is that appropriate for both spouses?
Maybe not. So where's the other spouse going to go if they wanna remain together? That's all part of your due diligent due diligence and your proper investigation.
I'm just gonna look at the chat.
So let's start at the top with Catherine's question. My stepfather is being admitted this week to Arber Terrace from the hospital. He has advanced Alzheimer's. My mom does not have power of attorney. They have been married eight years. Does probate need to be involved for her to get power of attorney?
Maybe, maybe not. It's, for, you said she has a dad's Alzheimer's. So My definition of advanced Alzheimer's would mean that your mom doesn't have the capacity to sign any new legal documents.
I may be off on that, but you use the the the term advanced Alzheimer's disease. And she does not have a power of attorney. So just because they've been they are spouse and spouse does not mean they have access to each other's finances if the assets are kept separately. For example, maybe your, maybe your mother, I'm sorry. You said it's your father. So maybe your father has a retirement account like an IRA, for example.
Well, just because they've been married does not mean that, I'm sorry, that your that your mother can access your stepdad's funds.
Someone may need if your dad doesn't have the capacity to sign a financial power of attorney You or your mother or someone on your stepdad's behalf may need to file for a guardianship action with wherever they live in their local county. So that's obviously beyond the scope of advising you individually based upon where you live.
But the only thing I can tell you, Catherine, is thank you for your question.
And I'm sorry that, your mom and stepdad are going through these issues, But I would suggest if your mom needs to access your your stepdad's funds to pay for ongoing quality care for him, I would suggest that you consult with a local elder law attorney in your jurisdiction.
And just, as a follow-up for Catherine, because this is something I would want to know if I was in the same situation, about how long does something like that take? If you're talking about getting guardianship and then getting funds released, how long does that process usually take?
Yeah. You have to look at what the process is in your jurisdiction, so I can't comment specifically. I can only comment based upon Pennsylvania and New Jersey. Anywhere between three to six months.
Okay. In the Philadelphia metro area. Okay. But That's good. Yeah. That's about the best I can do.
Okay. Yep. That gives Catherine a good timeline for her and her mother to work with. So Alright. Excellent. And she says, thank you very much. She says he has a great LTC policy.
Right. Fantastic. But even that, you know, you have to someone has to sign off on it. So even and gain access to it. So even that could be an issue. But I'm glad he has a LTC means long term care policy, which long term care insurance policy, I assume.
Which is fantastic.
Yes. Absolutely. So let's talk about long term care financing then.
I touched upon it earlier, but when you talk about long term care financing, there is a distinction between the different benefits. Private pay, that's relatively straightforward. Long term care insurance, the what Catherine just mentioned.
Not most of my clients do not have long term care insurance.
But if you have it, important to be able to keep the policy in play. It's great, and but it's a luxury. And some people who purchased pay for it over the years find it getting too expensive. And I get that, but it can be very helpful.
Medicare. I talked about Medicare and Medicaid already a little bit about, you know, found Medicare back to nineteen sixty five was never designed to cover long term care expenses.
Do not rely on Medicare to cover assisted living because it doesn't exist.
Medicare covers acute care, hospitalization, doctor's visits. It covers up to one hundred days of rehabilitation in a skilled nursing facility. It can cover short term home care, but Medicare was never designed to cover long term care needs. That's where Medicaid comes in. But, of course, Medicaid is Financially, you dependent based upon your assets. You have to be eligible for for Medicaid.
If you've paid into the system and through payroll or your spouse did, You're automatically entitled to Medicare at age sixty five or blind or disabled prior to age sixty five, but not everyone is automatically entitled to Medicaid. And as I alluded to, there's a difference between Medicaid coverage for nursing home and Medicaid coverage for assisted living, which is not nearly as prevalent
Also, veterans benefits. You are, the the issue with veterans benefits is that you have to be a veteran or the widow's of a veteran. So obviously a lot of people are already ruled out to receive benefits if you're not a veteran or widowed spouse of a veteran.
Without going into a great detail, there are situations that you may be entitled or your loved one or surviving spouse going to assisted living or even paying for home care may be entitled to to to veterans benefit benefits for a tax free Pension.
To receive those benefits.
There's much more information, by the way, on our website. So, again, a lot of this is much more detailed on our website. It's Rothkofflaw.com. And I think Melissa will share these. I can well, if someone asked the question, I think Melissa would be happy to share these slides with the attendees as well.
Okay. Yep. So that that typically is determined by the guest if they want to share those slides. So and you did answer that question.
So we are thankful and grateful that you are allowing that to be shared with our audience. And just as a reminder to everybody here in case this is your first time, you used an email to RSVP for today's webinar, and we will send this webinar in full tomorrow to that email. So you can send it to friends, family, and can rewatch it at your leisure. So, great question there.
And, Melissa, again, thank you for being a part of the conversation today. We we appreciate the interaction. So let's get to another question here, Jerry, from Mary.
If you have a health care, power of attorney, do you still need a POLST, a physician's, order for life sustaining treatment?
Mary, think of the health care proxy or health care power of attorney as an umbrella.
It's an umbrella policy. Think of it. So it's it it covers everything related to health care decision making. Okay?
However, a POLST is different, meaning that the the health care power of attorney can cover non end of life circumstances.
The POLST comes in at end of life, and it's and that's not something that is binding.
Because it's a physician's order, It's physician's order for life sustaining treatment. So it's different than your other documents, which are voluntary.
The POLST is a physician's order that goes into your medical chart, your electronic medical chart.
So it's it's voluntary, certainly, but it's about end of life. So if you're ever in a circumstance that that that unfortunately is an end of life circumstance, the it would be on your chart and a fit like, a physician's order, like a, like, do not resuscitate order.
That the physicians in your family would have to honor.
So it's different than a health care power of attorney. Because a health care power of attorney can simply be an exception to HIPAA rules, for example, saying, okay. You can give my spouse health care information in a non crisis circumstance or access a medical record as opposed to the POLST, which is an end of life physician's order.
K?
Okay. Okay. Mary, I hope that that answers your question, and and these are obviously very good questions. And, again, as we start to get to the back half of the hour, this is this is a really good time to type your questions out in the Q&A box at the bottom of your screen to get in on the conversation here with Jerry today.
Again, he's giving up great advice. Please take advantage. Alice has a question, and this may be directed specifically for you. I had a difficult time finding an elder care attorney
How do you find one? I am a legal guardian for my aunt who is at Arbor Terrace, Mount Laurel, which is in in New Jersey.
Well, I mean, you're preaching you're speaking to the choir here So, you know what I'm trying to say? So, I mean, I mean, you can certainly Google elder law, Mount Laurel, elder law, South Jersey.
You they're National Academy of Elder Law attorneys.
You know? I mean, there are some good ones in your area. I'll just leave it at that.
You're welcome to contact our office. If we can't help people, find someone who can. So we're we're we're we work up and down from Central Jersey down to the Jersey Shore and everywhere in between. So there are some good ones out there.
You just need to find them, and not every elder law firm does provides the same services. Just, so but, you know, you're certainly in our neck of the woods. So I I any questions, feel free to reach out to us. Can't help you, we'll find someone who can.
Good. Very good. And will you have a a slide towards the end of the presentation that has your contact information?
I believe it does. Yes.
Okay. Very good. Very good. Okay. Alright. We got another question here. Are are you still good taking questions now, or do you wanna continue?
Take one more, and then I'll move on because I don't wanna run out of time either.
Okay. One from Melissa back on the POLST, the POLST. So are you saying that if a loved one sat with his physician and said, these are my life ending wishes, and that POLST would be put in the loved one's Medicare record. Is that what you're saying?
Yes.
Okay.
It's a medical chart, not medic Medicare record, but I know what you're saying. Yes. That's what I'm Okay.
Perfect. I hope that answers your question. Jerry, continue.
Alright. So let's talk about moving to assisted living. What, some of you may already have a loved one in assisted living, whether it's an Arbor community or otherwise. But first of all, there is distinction between regular assisted living and memory care. And not every assisted living is the same.
Most a lot of people don't understand the distinction between assisted living and nursing home, and they use those, and they use the terms they interchange assist really, when they really mean nursing home and vice versa. And there's also, there's no one size, there are different shapes and sizes specifically in assisted living as well, meaning there are regular assisted living and then there's typically an assisted living memory care.
Some communities, like Arbor, have assisted living and memory care in different parts of the same building, and they're distinct parts of the building. And there are communities where that just offer memory care. Again, I'm not an expert. I'll let Melissa address it. I'm not I although I we have clients in Arbor communities, I don't provide counsel to Arbor. I'm totally set totally separate and apart from Arbor, so I can't speak exactly what their communities are like throughout the country. I can only speak what they are in the southern southern New Jersey.
And the, so you have to understand, sometimes memory care your loved one may go right to memory care, or sometimes they will transition to memory care after in their their the standard assisted living for a period of time. So but you want to explore the different options and what what's the right fit. There's no right or wrong. You would have to you have to understand there are different options available.
And, also, it's important if if finances are relatively limited, it's important to ask what their if your state does reimburse for assisted living care, you would wanna ask, what is your facility's Medicaid policy?
And is it in writing?
Also, I mentioned it earlier. What happens if the money runs out?
What, will they will they kick my loved one out of the community? Or can we stay here and maybe there's some type of benevolent fund in some circumstances? So what happens if I'm if we don't if you're if we're here, my loved one pays ten thousand plus a month and funds depleted and runs out. There's no more money to pay. What happens then?
Many of our clients have pets, and sometimes they will not leave their home if they can't take their pet with with them.
So if that and I understand it. I mean, I have I have I've had dogs for for many, many years.
And what is their pet policy?
Whether it's a cat, dog, rabbit, whatever it is, Will my loved one allow be allowed to live with their pet? And if so, what's the pet policy?
That's an important question for many of our clients.
How about an adjustment period?
Well, you know, where it's meaning the adjustment for two individuals or maybe even more than two. The adjustment for your for the individual who is moving to the assisted living community and the adjustment for the the a spouse or a child who who feels guilty placing their loved one into an assisted living community or other long term care setting.
What's that adjustment period like?
Yeah. Yeah. So that's that's something to consider.
Does it? Is it healthy to to visit the day after or the week after, your loved one transitions to an assisted living community. You'll get some great advice by the people who by the professionals who work in the assisted living community, but something to consider.
Also, what if a higher level of care is needed?
What if you're in memory care, but you need a higher level of care?
Who decides on whether you whether your loved one needs a higher level of care?
Can you bring in your own aid, like a one on one or a few hours a day to pro to supplement the the care that's provided by the assisted living community? All of those questions should be asked.
When we talk about other issues, one of the thing regardless of the community, it's like buying real estate. It's location, location, location.
You wanna be able to find a community that You can reasonably visit a regularly on a regular basis, one that's close to a home. Or if you're an out of state caregiver, find someone locally like a geriatric care manager who can check-in on your loved one on a regular basis, or of course a family member, friend, etc. Visit on a regular basis.
You wanna research before the crisis occurs.
You certainly wanna to, you if you're a resident, what are the what are the what are the, resident rights? I mean, You know, for exam we we saw what happened during COVID.
You know? So what what happened? I mean, it there's nothing wrong with asking these questions.
What happens if there's a pandemic like COVID? What's your policy?
What's your policy for if there's COVID in the building now? Which COVID never went away, by the way. It's still there.
K?
And, so COVID's still out there, and some communities shut down at least temporarily even today because of a COVID outbreak.
So any type of pandemic. Cove there will be something in the future because history will always repeat itself.
And I heard Doctor Anthony Fauci speak in Philadelphia about three weeks ago.
And he guarantees there'll be another pandemic within the next decade over something.
You wanna make unscheduled visits. And when we talk,I And I know that this is talking mainly about assisted living. But, you know, look, you wanna also when we talk about there's some changes in nursing, saying, but you wanna look at their staffing.
And here's what you shouldn't go by exclusively.
Although it's something to consider. You know, There's all different types of reviews from Yelp to Google to different, senior care websites that rate different communities.
That's something to consider, but I wouldn't take it as gospel.
Because there's a lot Unsaid. And if you it's all It's important to simply communicate there at the community with other family members of loved ones and ask them about what what they see.
So with that, I'll be happy to answer any other questions that you have.
You know, if you're local in the South Jersey area or the Philadelphia metro area, there's our website. We have a whole host of events or a lot of information to that you can follow-up on, on our website. And you ask for my information, and there's our, our elder law firm information. Okay? There's our there Rothkofflaw.com.
Perfect. And we'll just keep that up here in the final minutes of the webinar. Again, a really good time. About ten minutes remaining to get your questions into Jerry regarding his advice and digging deep into his knowledge about how to help you or a loved one make that transition into assisted living. Jerry, lots of really good information here today, but I'm curious. What what do you find people come to you the most about that you you kinda wish everybody knew. You know, the education was a little bit better on.
What I just talked about. Okay.
Me.
Yep.
We yeah. We're there to help peep individuals and families navigate the health care system.
And people do not understand the average person, I should say, because they have no reason to deal with it previously, do not truly understand how convoluted the health care system is, especially when you're you're dealing if you're a caregiver for an older adult who needs care.
You know, what's the difference between Medicare and Medicaid? My late husband was a veteran. What VA benefits are available? What's the difference between regular memory care and assisted living? Well, why doesn't Medicaid cover assisted living, but it covers nursing home care? Why doesn't Medicare cover home care on an ongoing basis or assisted living?
Isn't that what I paid into the system for?
My long term care insurance covers nursing home, but why doesn't it cover home care? I never knew that. I just assumed it would but now I look at the policy, I'm told there's no coverage for home care, only nursing home care.
So you know? And depend some of this is based upon state law as well. So it's important to plan ahead, especially if you have a loved one diagnosed with some type of of syndrome where you know care is going to to be needed. Alzheimer's, Parkinson's, an individual who's a stroke survivor and has certain deficits after surviving the stroke.
Those are all important issues to deal with. Those are care issues which we address. And then, of course, you have the financial and legal planning issues, making sure you have updated financial health care powers of attorney. You have an updated will based upon your specific situation.
The Then, You know, is and based upon your your your individual situation, do you is it a second marriage for you? Do you have stepchildren? That that changes the equation just a tad.
You may have a child who has a special who has a special need, And that maybe you need to engage in some special needs plan to protect your child living with a disability. I'm talking about an old an adult disabled child. I'm not talking some a minor child. Maybe that you, you may Wanna stay at home.
but
Is your house conducive for you to remaining at home? Maybe you live in a split level with lots of steps.
Maybe significant neuropathy, and I unable to navigate the steps very well.
And so, you know and if you are a caregiver child, well, know, you gotta start planning ahead of time. Can't say you can't say, mom, okay. Let we're going to Arbor Terrace today. I'm gonna drop you off there, and this is gonna be your new home. That that will not play out very well, generally speaking.
So you you need to to help you need to help facilitate all of these issues. So in a perfect world, to make a long story quite long All of this will be addressed be addressed in advance. But We don't live in that perfect world. We live in human in the world of human nature.
And human nature says, I we will procrastinate because we do not wanna think of bad stuff.
We're gonna we're gonna, we're gonna spend hours on Google and TripAdvisor planning our next Vacation.
But will not even consider reviewing options to care for mom for the rest of her life.
Yeah.
Yep. And many of us have experienced that, are experiencing that firsthand, and and it is very difficult. And, you know, the last thing, and we we preach this all the time on our webinars, is don't wait until it's an emergency. Everything becomes two, three, four times harder than it really needs to be at that time. I have a question for you, Jerry, and this goes back to Medicare. You did touch on that
Should people stay with the traditional Medicare or should they move forward within those Medicare Advantage plans that you see all over the television and commercials?
It's a very difficult excellent question. Very difficult question to answer because it's very fact specific based upon your individual circumstances.
I would suggest if you look now we're in the annual enrollment period, which started today. And goes, I believe, through December seventh, the annual Medicare enrollment period that is.
I would suggest that you meet with someone in your local area who is very knowledgeable on Medicare coverage and and then review your options, what your prescription drug coverage is, what your individual situation is. Do you have traditional Medicare now? Do you have what's called a Medicare HMO, which is a which is a Medicare Advantage plan that you were referring to, sometimes referred to as Medicare Part c.
You would wanna review those options.
And determine what's best for you. If you have a a a traditional Medicare plan, meaning part a and b, and then you have a Medigap plan, maybe that's gonna be good enough.
However, what I will warn you, though, is that if you have traditional Medicare with a Medigap plan, which covers co pays, things of that nature which is an extra premium. And then you switch over to a Medicare Advantage plan because you like the benefits that it offers.
You may not and you decide that that medic Medicare Advantage Plan, which is a Medicare HMO, is not appropriate for you any longer and you wanna go back to traditional Medicare, you may not be able to pick up another Medigap plan because a Medigap plan, most people do not know can discriminate against you because of a preexisting condition. So if you're diagnosed with all with some type with mild cognitive impairment MCI as it's referred to, or you've been diagnosed with with Alzheimer's disease even though, know, you don't have any you're totally independent.
You can be denied a Medigap policy because of the preexisting condition.
So you wanna think long and hard about switching. Also Medigap coverage is not for everyone.
History shows that if you have Medigap coverage, you're more likely to be to be denied coverage for certain conditions, certain procedures.
And one of the reasons without going into detail, because I think we're past the hour at this we're about to head up to the sixty minute mark at this point. One of the issues with the Medigap policy is that you're gonna see more and more usage of AI to deny claims.
So and we're you're starting to see that more and more. You artificial intelligence is being used to review claims and deny claims, specifically by Medicare Advantage plans.
So, again, I guess you see my bias already without me coming out and say it, but be very cautious of Medicare Advantage plans. You there's a there's a lot of advertising, especially this time you're going on. You'll see on TV and radio
But it's not all it's made up to be. You know? All the benefits, it's not it's advertising. That's just keep that in mind.
Yeah. And I'm glad you you pointed some of that out. And I I did not know about the AI, but that I could shake my head, but then I'm kind of like, oh, well, you know, that sounds about right with everything else in terms of health care and the way that we we sort of go about it in the United States.
I think, we had a comment there, and Melissa says that Clark Howard, says to stay with traditional medic Medicare, for, some of the reasons that, I guess, you mentioned, there, Jerry. One more question from me, and then, and I know that we could probably talk forever about all these topics, but long term care insurance. Right? Sounds great. You know, you could pick it up when, you know, you're around my age or what have you, and as you continue to pay, it gets more expensive to the point where you're wondering if it's even worth the continuation of the payment for the premium. Can you talk about long term care?
And for those who are questioning it now, and can get in on it now, is it worth it?
It is worth it If you have long term care insurance policy and you can afford the premiums, may have risen, I don't recommend changing the The, Keeping it.
However, it's very expensive.
Yep. And most of my clients do not have long term care insurance. If you're able to purchase it, purchase it. Again, it's very specific.
I mean, you have to look at what your individual situation is. Some individuals are fortunate enough to self insure. They have enough assets. They don't need to insure against the risk of long term care.
For example, if your spouse and spouse, we work with a lot of school teachers, a lot of retired school teachers.
And that school teachers generally have a state pension. And if you're spouse and spouse, you may have over ten over ten, twelve thousand dollars in fixed income between your Social Security and pension. So maybe you need less insurance because you're guaranteed a hundred and twenty or a hundred and fifty thousand in annual fixed income between your spouses.
So you have to look at what your individual situation is. There's there's not one hard and fast rule.
But if you can if you can insure against the risk, it generally makes sense to do so, but it can be very expensive.
Okay. Alright. Jerry, I think we are coming off to the top of the hour. Let me just make sure we don't have any additional questions here, and we do not we do thank all of you, of course, for for chiming in here today to get your questions answered by Jerry, who obviously did a fantastic job with all of the questions.
And, Jerry, we just thank you for taking the time to share your knowledge and answer all of our viewers' questions. As I said, great webinar, extremely informative, and I feel like we've just literally touched the tip of the iceberg of all of these topics here today. But, again, very well done. Please, please, please come back.
Alright. Well, thank you so much, Melissa and Arbor Terrace, for inviting me. I hope you found it worthwhile and the attendees found it worthwhile. Any follow-up questions, please. You have our intro. You're welcome to contact us, and we'll make sure everyone gets a copy of these slides that Melissa can send out.
Yeah. Fantastic. Well, thank you again for being with us. And, for those of you watching, if you enjoyed this webinar with Jerry and you found it informative, which I'm sure you did because I know I did, please head on over to our website. It's www.seniorlivinglive.com. We've got webinars all, about senior living just like this one. And the best part, all of our content is free, and it is on demand at your convenience.
Thank you so much everybody for being with us. Have a great day.
Bye bye, everyone.