Long Term Care – Where You Live Makes a Difference
There is a reason why elder law attorneys serious about the practice decide to join the National Academy of Elder Law Attorneys (NAELA) and, in Pennsylvania, the Pennsylvania Association of Elder Law Attorneys (PAELA). The reason is that the laws, regulations and practices can differ widely from state to state and sometimes even from different areas within the state. Members of NAELA can quickly connect with similarly involved members in other states and counties and especially with Certified Elder Law Attorneys (CELA’s) in these locations to provide information and contacts for their clients.
Suppose your parents live part of the year in Florida and part in Pennsylvania and a decision needs to be made where they should receive long term care. Is Florida or Pennsylvania the better choice? If you live in Pennsylvania and your brothers and sisters in California and New York, how do you know? It is not just a question whether they might leave home but also what supports and funding are available and, if a continuing care retirement community is involved, what are the terms of the contract. What are they committing themselves to? Even within a State there can be dramatic differences depending on whether the area is rural, suburban or metropolitan. Private availability, taxes, and government and private programs vary. When we can get on the phone or email a member attorney in another state for details in their state we can better answer questions that benefit our clients. We can also confidently refer. States can differ dramatically when it comes to long term care regarding availability, quality, government benefits, retirement communities, and cost.
If you are nearing retirement and you open an attractive brochure advertising a senior community with golf courses and swimming pools in North Carolina, you might reasonably hesitate before signing on with your spouse because you do not know what options are available if you need some serious care. Is it a life care contract? If so, it might need to be examined in detail to get the answers. What happens if you want to move back to be near the kids or if you run out of money? Also, what states are better for living trusts and which ones use more will-based planning.
If you are a “snowbird” and live most of the year in Florida and return to Pennsylvania during the summer are you better off eventually to live full time in Florida or in Pennsylvania? Florida has a very generous homestead exemption for property taxes.
These questions are faced every day by ordinary people. There are even firms on the border between the U.S. and Canada that specialize in planning whether Americans who commute to their vacation homes in Canada should move or stay based on finances and regulations.
Some years back I co-authored a book titled “The Medicaid Program: Interstate Planning Opportunities in Pennsylvania and Delaware” addressing the difference in Medicaid programs between two adjoining states. With our office close to the borders with both Delaware and Maryland it helps to know differences.
If you live in Pennsylvania and receive long term care services and supports here whether in a nursing home or at home under the Medicaid Waiver Program, your spouse’s retirement funds – IRA, 401(k), 403(b) or similar – (not yours) are exempt for Medicaid regardless of the amount. If you cross the bridge to New Jersey they are counted and would be spent down as part of the Medicaid spenddown. The difference to the couple could mean hundreds of thousands of dollars’ lost or saved.
Delaware, and, for that matter, New Jersey, have limited Medicaid availability for assisted living/personal care. Not in Pennsylvania where there are strict income guidelines.
So what is the answer? Our office researches the laws in other states and connects with other elder law attorneys in areas where clients expect to move. This is one time among many when it pays to belong to a national organization like NAELA to further relate to other elder law attorneys who concentrate in this field across the U.S. Whenever and wherever you move – or if you decide not to – there are answers and we are prepared to research and provide them.
About the Author Janet Colliton
Esquire, Colliton Law Associates, P.C. Janet Colliton has practiced law for over 38 years, 37 of them in Chester County, Pennsylvania, a suburb of Philadelphia. Her practice, Colliton Law Associates, PC, is limited to elder law, Medicaid, including advice, applications and appeals, and other benefits planning including Veterans benefits, life care and special needs planning, guardianships, retirement, and estate planning and administration.