Contact us with questions about this topic.
Contact us with questions about this topic.

Are Hybrid Insurance Policies a Better Option than Long-term Care Insurance Policies for Meeting Nursing Home Costs?

Many people are aware of the high cost of nursing home care. Unfortunately, nursing home costs in Massachusetts rank as some of the highest in the nation and can exceed $12,000 a month. Some insure against these potential costs by purchasing long-term care insurance (LTCI). However, LTCI polices are not without their drawbacks. LTCI premiums can be high and there is generally no residual death benefit if the insurance is not used. Insuring against a risk that may never come to pass without any return on the investment does not sit well with some.

One alternative to purchasing a LTCI policy is to purchase a hybrid life insurance policy that provides long-term care benefits. While hybrid premiums can be five to fifteen percent higher than LTCI premiums, these policies provide a residual death benefit that regular LTCI policies do not. While the downside is if the hybrid policy holder does indeed require long-term care, the value of the death benefit is diminished by the payments made by the insurer toward nursing home care, for many the chance of providing a death benefit for surviving loved-ones is worth the price of the increased premiums. Hybrid policies also function as low-yield investments, which is another benefit they have over regular LTCI.

Of course, those that cannot afford long-term or hybrid policies or are too unhealthy to pass underwriting have other options and can employ trust and gifting strategies that render hard-earned assets uncountable by MassHealth. Contact the Law Office of Brandon L. Campbell for a complimentary telephone consultation to see if any of these strategies may be right for you.

Elderly Woman Exiting Car
Elderly Woman Exiting Car

Is Assisted Living or Senior Living the Better Choice for My Elderly Loved One?

If you have an elderly parent or other loved one that is in need of care, you might be wondering where to start researching your options. Though the senior citizen population grows every year, the amount of senior housing options has not kept up with that growth and therefore limits the choices that your loved one might have. The terms assisted living and senior living or housing are thrown around a lot, but are you aware of the differences between these two?

What Is an Assisted Living Community?

An assisted living community is for senior citizens that are usually 85 years old or older. There is a large range of different assisted living communities that offer different services; some are targeted for especially frail seniors that cannot take care of themselves at all, and others are for seniors who need basic care. Some assisted living communities will offer on-site nursing care, while others will have both on-site and off-site care. The main descriptive factor of this type of elderly living is that there is some sort of assisted care offered. This can include help with bathing, dressing, grooming, or eating if necessary. They don’t, however, offer extensive medical care, which is what differentiates this choice from a nursing home.

What Is a Senior Living Community?

This type of elderly living community is for retirement age-seniors and older. There is no in-home nursing care offered at these facilities, and residents have easy access to clubs, social groups, and sports activities. This living community is intended for relatively healthy elderly adults that are 60 or older. They will sometimes be equipped health and fitness centers, pools, movie theaters, bowling alleys, and spas. This is a great choice if your elderly loved one is able to live independently, and he or she would like to find a community with other seniors.

If you are still unsure what the best choice is for your senior family member, you should consider hiring an elder law attorney. The law office of Brandon L. Campbell can assist you and your loved one with deciding the best option for long-term care, based on his or her physical and mental needs. Contact us today for a free consultation to get started.

What to Do If Your Loved One Refuses Long Term Care

One of the most common and difficult caregiving challenges that an adult can face is dealing with an elder loved one who refuses necessary assistance. Whether he or she is resisting in-home aides, driving under ill or weakened physical conditions, or just generally denying help from any family members, it can be hard to decide how to handle the situation. Especially if he or she is experiencing early levels of cognitive impairment, there will be clear signs of confusion or fear of what’s happening to them. As their adult child or close family member, there are a few things you can do to make this process run a little smoother.

What Are Some Strategies to Help Me Overcome My Loved One’s Objections?

  • Start the conversation early: Don’t wait to have the conversation of implementing care for your loved one when there is a health crisis. Start a casual discussion early on and introduce the idea as a plausible outcome in the near future.
  • Be patient: Make sure to ask open-ended questions and give your loved one plenty of time to answer. These are hard things for anyone to think about, so let them have the time to give you an honest and helpful answer. Don’t be surprised if the conversations veer off-topic; realize this might take several talks before you get a beneficial response.
  • Deeply explore: Really try to determine why your elder loved one is refusing care. Ask questions that actually foster a solution- is it about privacy, financial concerns, loss of independence, or a combination of the three? Patiently figure out the root of the problem.
  • Offer options: Include your loved one in interviews, meetings, or schedule setting in order to discuss the various options that he or she can take. There are levels of aid that a helper would give, and they can be around for only certain days of the week or certain times of the day.
  • Accept your limitations: Realize that in the end you should let your loved one make their own choices, as long as they are not endangering themselves or others. Bad things might happen and you can’t always be at your loved one’s side. Accept the limits of care that you can provide and don’t feel guilty.

If you would like more assistance in helping your elderly loved one accept the care that they need, contact our Massachusetts elder law attorney today.

Marriage and the Nursing Home

A touching article in the New York Times is circulating on social media sites describing the marriage of two people well into their nineties in Middletown, New York. Putting romantic issues aside, from the stand point of protecting assets from the nursing home, marriage can be beneficial or risky depending on the assets each spouse brings to the table. In general, an unmarried individual is allowed to have only $2,000 in assets to qualify for MassHealth nursing home benefits. For a married couple, the institutionalized spouse is again limited to $2,000, but the non-institutionalized spouse is allowed to have at present $120,900, called the Community Spouse Resource Allowance, with no “look back” period applicable to transfers between spouses.

It follows that couples with relatively small estates may be able to shelter more assets by getting married, whereas couples with larger estates may be putting more assets at risk.

NAELA President Hy Darling: Medicaid Cuts Proposed by Senate Will Hurt Seniors and Disabled

A letter from the President of the National Academy of Elder Law Attorneys, Hy Darling, to members outlines the damage that will be caused to seniors and the disabled if the recently released Senate healthcare bill is enacted:

Dear NAELA members,

Yesterday, the Senate released its initial version of the American Health Care Act, called the Better Care Reconciliation Act.

I appreciate that the Senate heard NAELA’s concerns regarding the provision in the House passed American Health Care Act that would have imposed new restrictions on how much home equity states could exclude when an individual applied for Medicaid. This provision would have been particularly harmful to individuals with disabilities in high-cost areas who wished to remain at home.

Unfortunately, the Senate version of the American Health Care Act makes even worse the House’s radical changes to Medicaid by capping the federal government’s commitment to individuals with disabilities and low-income seniors, putting their health and well-being at risk. Then, starting in 2024, it limits federal payments to the states based on the growth of the Medicaid inflation, which, over time, could be insufficient to keep up with the cost of care. This could not come at a worse time, as the population of Americans over the age of 85 grows rapidly.

As members of the National Academy of Elder Law Attorneys (NAELA), we represent individuals faced with significant long-term care needs. These are some of our nation’s most vulnerable people. Many require assistance to perform the most basic life functions. Their families are emotionally, physically, and financially exhausted from the process. They have had their dignity stripped and lost their life savings as a result of illness and disability.

Many of us cannot imagine ourselves in such a situation, but disability and disease can happen to anyone. For many people, including most middle-class and working-class Americans, it’s Medicaid, not Medicare, that provides them with care in these situations.

Changing Medicaid’s financial structure for the worse without addressing many of the underlying issues in the program only exacerbates these problems. Take just one example: Providing services at home is optional while more costly institutional care is mandatory. States under new budget constraints from the per-capita cap may keep the mandatory and jettison the optional. So the change in financial incentives puts Americans, such as those with dementia, a spinal cord injury, or children with developmental disabilities, at risk of being institutionalized when they could otherwise receive care in a less restrictive, less costly, more comforting setting.

The Senate also continues with the House’s repeal of Medicaid’s three-month retroactive coverage. Without retroactive coverage, the families of seniors discharged to a nursing home after a traumatic accident could be liable for tens of thousands of dollars of nursing home costs, which facilities may then deny them entry because they lack sufficient funds.

Medicaid can be improved upon so that individuals with disabilities and older Americans can receive the long-term care they need, without having to become destitute to do so, without having to put unneeded stress on their families. The Better Care Reconciliation Act, as proposed by the Senate, does not do that. It simply makes an already bad situation worse.

I urge all members to call their senators and ask them to vote against this legislation . . ..


Hy Darling, CELA, CAP
NAELA President

supreme court
supreme court

New Guidance from SJC on MassHealth Planning

The Supreme Judicial Court rendered its long-awaited decisions in Daley v. HHS (SJC-12200) and Nadeu v. Medicaid (SJC-12205) today. The Court held that “neither the grant in an irrevocable trust of a right of use and occupancy in a primary residence to a [MassHealth] applicant nor the retention by an applicant of a life estate in his or her primary residence makes the equity in the home owned by the trust a countable asset for the purpose of determining Medicaid eligibility for long-term care benefits.”

The decisions make clear that transferring a primary residence into an irrevocable trust, properly done, will not make the residence countable for purposes of determining MassHealth nursing home benefit eligibility after the MassHealth five-year lookback period has run, so long as the applicant does not have access to principal under “any circumstances.” The value of a life estate retained by the grantor remains countable as well as any income to which the grantor of the trust is entitled.

The decisions describe some traps for the unwary. Such trusts should circumscribe trustee discretion to appoint trust assets to a non-profit organization. Provisions such as this are sometimes included to qualify for favorable tax treatment, or “grantor trust” status. Many skilled nursing facilities in Massachusetts are run by non-profits, and if the nursing facility meets the definition of a non-profit set forth in the trust, this may make the trust assets countable. Also, trust language that provides for the use of trust principal to pay for taxes creates countability. Lastly, the opinions suggest that the value of a grantor’s use of the premises, i.e. the fair market rental value, under a use and occupancy agreement is a countable asset.

MassHealth Still Considering Tightening Pooled Trust Regulations

The Boston Globe reports today that MassHealth is still considering treating pooled trusts set up by people over 65 as countable for determining nursing home MassHealth eligibility. The proposed changes, if enacted, would further limit items that seniors may spend down assets on without disqualifying them from receiving benefits.

Beverly Elder Abuse Rally Today

June is Elder Abuse Awareness Month. In honor of this, and to raise awareness concerning this important issue, a rally was held in front of Beverly City Hall today. According to literature provided by Scott Trenti, the Executive Director of SeniorCare Inc., an organization that has served elders and disabled adults on Cape Ann and the Greater North Shore since 1972, 85% of elder abusers come from the elder’s own family. Abuse can take many forms: physical, sexual, or emotional abuse, to financial exploitation, neglect, or even self-neglect.

Elder abuse should be reported to law enforcement, regional protective services programs such as SeniorCare, or the statewide Elder Abuse Hotline (1-800-922-2275). The hotline is available on a seven day a week, 24 hour a day basis. Click here for additional information.