LONG TERM CARE PLANNING

Program of All-Inclusive Care for the Elderly (PACE)

Medicaid Funding for the Program of All-Inclusive Care for the Elderly (PACE)

For those who are financially and medically qualified for long term care Medicaid, but who still remain safely in their home, the PACE program provides an interdisciplinary team whose focus is on maintaining the senior at home. To qualify, the senior must be at least 55 years of age, must reside in the coverage area for the local PACE program (Hampton, Newport News, Poquoson and southern York County) and must meet medical criteria for nursing home care. The PACE program accepts both Medicaid and private pay clients. It provides day care, with a physician, pharmacy, recreational therapy, meals, transportation, and other supportive elements to maintain the senior in his or her own home.

The financial requirements for PACE are the same as for Medicaid, except that the home is exempt.

What to Expect at Your Appointment

When you make an appointment for a long term care consultation, you will be mailed some documents to review and complete. Please take this seriously; our advice to you is only as good as your information to us.

The first step is normally a meeting with the case manager assigned to your case. The case manager, either Donna or Annie, will meet with you to review your finances and be sure that we are aware of all relevant financial information. This generally lasts a half hour. It is followed by a meeting with the attorney.

Your appointment will be with attorney Susan I. Jean or attorney Elizabeth E. Bircher. The appointment will usually last about one and a half hours. During this time, the attorney will review the situation and the information you have provided, will determine what your questions or concerns are, and will provide a recommendation in short written format. That will end the consultation.

If after the consultation you believe we have demonstrated the expertise you want in your Elder Law attorney, you may become a client of the firm by retaining us to assist in implementing the plan. Such a retainer is appropriate when the client is not able to execute the plan on his or her own. This may happen when the spouse is committed to visiting the spouse in the nursing home and does not have the time to collect the information needed for a Medicaid application, or when the spouse is not financially astute, or when the applicant is single and the family needs assistance, or when there are many undecided aspects to the plan such that it is likely to change. The retainer normally combines:

• a detailed, written Long Term Care plan; and
• any necessary estate planning to support the plan; and
• case management to assist with executing the plan; and
• assistance with filing the Aid & Attendance or Medicaid application, and representation through first level appeal if necessary.

In many instances there are estate planning issues to be addressed. Our estate planning attorneys, Christina C. Balaban and William H. Carmines would meet with you and assist in this regard.

Your case manager will keep in close contact with you to review the status of spend-down, gifts, and other elements of your government benefits plan. The case manager will assist with getting the needed documentation for the application, and will assist with completing the application. The case manager will speak with the attorney if there are any legal issues to address. Of course, you always have the right to speak with your attorney as well.

We will stay in touch with the Department of Social Services and will answer any questions they may have. If the application is delayed beyond what is considered appropriate, we will file an appeal, or take other actions designed to expedite the approval.

When approval is received, we will review the results to be sure that you are receiving every benefit to which you are entitled.