As part of its advocacy for quality of life for seniors, the Massachusetts Chapter of the National Academy of Elder Law Attorneys (MassNAELA) is filing four bills for the 2009-2010 legislative session that affect the state's elder population. The bills focus on improving the ability of elders to remain financially independent and in their home while dealing with the cost of long-term care.

"Our efforts at the State House make a tremendous difference for elders," states Suzanne Sayward, president of MassNAELA. "In this time of financial crisis, it is critical we do all we can to allow elders to remain in their homes with sufficient income and resources to provide for their needs. We are very pleased that so many Representatives and Senators have signed onto our legislation supporting elders' financial security."

The four bills recently filed by MassNAELA are as follows:

"An Act to Help Families Care for Frail Elders," sponsored by Senator Mark Montigny and Representative Kay Khan, would allow elders to compensate family members providing in-home care-giving services without violating MassHealth eligibility rules. The bill would permit family members to leave employment to care for loved ones, thus preventing nursing home placement and saving costs to the MassHealth program.

"An Act to Provide Financial Security for Spouses of Nursing Home Residents," filed by Senator Jamie Eldridge and Representative Alice Peisch, would help community spouses of nursing home residents retain their Individual Retirement Accounts (IRA's) as non-countable assets when the resident applies for MassHealth. Allowing spouses to keep their retirement assets provides them with additional income and resources while they are dealing with the substantial cost of nursing home care.

"An Act Relative to Nursing Facility and Long Term Care Claims," sponsored by Senator Robert O'Leary and Representative Chris Fallon, concerns MassHealth's exemption of the estates of individuals with minimum long-term care insurance coverage from its estate recovery claims. This bill would allow the use of such coverage for community-based care before entering a nursing home without forfeiting the exemption from MassHealth estate recovery. Allowing seniors to use their long term care insurance for community-based care will enable many more elders to remain in their homes rather than forcing them into institutional care.

"An Act to Correct the Income Calculation for Spouses of Nursing Home Residents," filed by Senator Gale Candaras and Representative John Fernandes, would correct the unrealistically high interest rate that is used by MassHealth to deem investment income to the community spouse of a nursing home resident. Most seniors invest in shorter-term investment products such as money market accounts, which have relatively low interest rates. Use of a money market interest rate to deem marital income to the community spouse would provide additional assets for their support.

MassNAELA's most recent legislative success, Chapter 125 of the Acts of 2008, orders financial institutions to not charge fees for providing up to 5 years of retroactive bank records for a MassHealth applicant or recipient who has a written request signed by a MassHealth employee or agent.

Anyone with questions regarding these bills or interest in expressing their support may contact their local state representative or state senator.

The ombudsman is a trained volunteer who visits nursing homes on a regular basis, and investigates and resolves resident and family concerns.  While the goal is to have the issue resolved within the nursing home, the ombudsman can involve the program director if needed. If the issues remain unresolved, the State Ombudsman Office or the Department of Public Health can offer assistance. 

Some of the rights of a long term care facility resident are:

• The right to be informed of the rules and regulations governing the facility.
• The right to adequate lighting, ample fluid and appropriate exercise.
• The right to choose your own physician.
• The right to use a telephone in private, and to be able to make outgoing calls.
• The right to confidentiality.
• The right to examine your records, and the results of State surveys done at the facility.
• Freedom from reprisal, verbal abuse, physical abuse, injury and discrimination.
• The right to information about charges, medical procedures and the services available.
• The right to information about the Ombudsman Program and how to contact the ombudsman. 
• The right to manage your own finances.

For more information on the ombudsman program, including a complete list of nursing home rights and the contact information for the ombudsman in your area, visit the Massachusetts Long Term Care Ombudsman website by clicking here. 

The goal behind these videos and the work being done by Health Care for All’s  Consumer Health Quality Council is to bring awareness to the problem and advocate for quality improvement and patient safety in health care. 

1. Copies of birth certificates, driver’s license or citizenship papers.  If you were born in a foreign country, these can be difficult to obtain, and obtaining copies of citizenship papers can take time.
2. Copies of all health insurance cards including Medicare.
3. Copies of at least 3 months of bank statements for all bank accounts, including those you share with another person, and accounts which have been closed in the last 3 years.  This means checking, savings, money market, CDs, and passbook accounts.  You will also need to provide an explanation of all withdrawals over $500.00 (and sometimes lower amounts).   You may also be asked for records of where certain deposits came from. 
4. Proof of all income.
5. Copies of the first page of all life-insurance policies, and a letter from the insurance company regarding the cash value of certain policies.
6. Proof of value of stocks, savings bonds, mutual funds.
7. Copies of annuity contracts.
8. Copies of deeds, current tax bills and amounts owed on all real property that you have an interest in – whether it it your principal residence, a vacation home, or a life estate that you hold in certain property. 
9. Copies of the registration for each vehicle, proof of outstanding loans and the current value.
10. Copies of funeral trusts, burial accounts or prepaid funerals.
11. Copies of any trusts of which you are the grantor, trustee or beneficiary, and documents showing financial activity of the trust.
12. Copies of proof of your at-home spouse’s living expenses.
13. Documentation and explanation of any transfers you made in the last 36 months of any funds or property.
14. The last two years of tax returns.
15. Clinical information on the applicant, which must be sent in by the facility. 

After the application is filed, there will be a request for more information mailed to you which will often require further explanation of certain things like deposits for withdrawals, proof of certain transactions,  and updated statements for all accounts.  You will have a limited amount of time to get this additional information to MassHealth, and it must be received by MassHealth by the date indicated or it could impact your eligibility.   

It’s a good idea to keep your records up to date, and not discard any old passbooks from closed accounts, or bank statements.  Even if you don’t need assistance now, you may in the future, and it will save time if you have easy access to your records.  It will also save your family time if they have to take over management of your assets at some point in the future or apply for Medicaid on your behalf.

I provide assistance in preparing and filing MassHealth Applications.  Please call me to set up a consultation if you need assistance with this process, or if you think you or a loved on may need to file a MassHealth Application in the future. 

The Massachusetts Department of Public Health provides a Quality Rating Tool for Nursing Homes for the public.  This Quality Rating Tools provides information in 5 areas which is gathered by the DPH during surprise visits to facilities: Administration, Nursing, Residents Rights, Kitchen/Food Services and Environment.  (I have put this link in the sidebar under "Resources" so you can easily find it again.)

You can search for nursing homes here and get information on choosing a nursing home.   The site also provides suggested topics and questions to ask when evaluating a nursing home. 

Tools like these are important because you can’t always judge a facility just by the way it looks.  However, if the facility does not look or smell clean, and if the residents seem poorly cared for that is probably an indication that you want to look somewhere else. 

If you need help evaluating a nursing home either because you aren’t sure what to look for, or if you live outside of Massachusetts and you are trying to find placement for a relative here, there are geriatric care managers and other professionals who can assist you in the evaluation of the facilities, so you can make the right choice for yourself and your loved one.