Planning with a disabled spouse not easy
When a spouse has been diagnosed with a chronic disabling illness, both parties are faced with decisions. The options can seem overwhelming and each professional consulted seems to know only a piece of the puzzle.
This can be an interesting hurdle for my practice since, if elder law attorneys do anything, it is to assemble the puzzle pieces and find solutions.
In some cases, the solution may be to catalogue the relatively sparse offerings for families in at-home care and assist them to access programs. It may be to suggest assisted-living, adult or respite care.
It may be to assist in the move to long-term care, to locate and negotiate with facilities and to try to preserve all assets reasonably possible so that the spouse who is living at home can survive financially and live reasonably well under the circumstances.
In Pennsylvania, this may entail additional early applications, such as the Hurly Stipulation, or hearings with the DPW Bureau of Hearings and Appeals cataloguing “exceptional circumstances,” such as heavy medical expenses for the spouse at home.
This kind of planning requires: knowing what assets are available to the couple; what benefits may be made available through employment or retirement plans with private employers or individually; and what benefits could be accessed through government programs.
Medicaid — the largest public funding source for long-term care and consumer of a major share of the planning — is not the only government program that must be considered.
Sometimes, Medicare benefits can be extended a bit longer to allow additional therapy and a breather when decisions can be made. Veterans’ benefits can occasionally provide health insurance or even, in some cases, long-term care.
Tri-Care for Life and Aid and Attendance are only two of the programs that require extensive review.
Relatively speaking, planning is easier for couples over age 65. After a mere three years or more of concentrated daily experience, it is possible for the practitioner to navigate the system reasonably well. After five years or more of concentrated daily experience in the field, creative solutions to problems present themselves almost every day.
It is harder to assemble plans for the under-65 group.
After several years of this, I have come to the conclusion that the system is different, actually harder, for couples under age 65 where one is disabled than it is for couples over 65. Although neither plan, program nor application could be considered easy by any imaginable stretch.
There may not even be an acceptable solution, particularly for spouses where disability strikes young, but only several partial solutions.
For couples over age 65, much more can be done than they realize, especially if they begin early.
Not only the federal system, but American society at large, makes different assumptions about people under and over age 65.
The common wisdom goes, people under age 65 work and are reasonably healthy. Over age 65, people are assumed to be retired and prone to illness.
The practical effect is two entirely different systems:
For the over-65 group, we use Medicare coupled with private Medicare HMOs or Medigap insurance policies primarily, a period of private payment and Medicaid. Private disability insurance does not pay out over 65.
For the under-65 group, we consider:
- the need for workers compensation if injured at work;
- private, long- or short-term disability insurance, placed by the individual or available through his or her employer. If available, early disability retirement may be an option; or
- social security disability for those chronically disabled who worked.
Supplemental Security Income, a needs-based (welfare) program, is available only if the assets are so low that most private attorneys — outside of legal aid or pro bono programs — would not even be consulted by applicants. SSI recipients do receive Medicaid for health insurance, but typically only when assets are down to $2,000.
SSI for those under age 65 does not have the (prevention of) Spousal Impoverishment Rules that apply to spouses of disabled persons where the disabled person is over age 65, which allow spouses to keep 50 percent of the joint assets up to $92,760 and sometimes more, where special applications are made.
At any age, the puzzle pieces require assembling to see the full picture.
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.