New Elder Abuse Law

There is a new law relating to elder abuse that criminalizes elderly financial exploitation…this law is not limited to an incapacitated person.

• Makes it a crime for fiduciaries who knowingly, or recklessly for their own profit or advantage, deprive or take real or personal property of an elderly, disabled or impaired adult for the benefit of someone other than the adult.
   
• Makes it a crime for a person through the use of undue harassment, duress, force, compulsion or coercion acquires possession or control of an interest in real or personal property of an elderly, disabled or impaired adult, or establishes a relationship with a fiduciary obligation to an elderly, disabled or impaired adult that gives the person control or interest in real or personal property or other financial resources.
   
• Prior to this statutory change, unless the incident involved an obvious crime, like a forged check, the police often considered reports of financial exploitation to be family or civil matters allowing the perpetrators to continue the exploitation without fear of criminal liability, which as you can imagine was very frustrating.

Things You Should Know About Elder Abuse Law in NH

Did you know that you have a duty to report elder abuse?

Any person who suspects or believes that an incapacitated person may be the subject of exploitation is required under NH law to file a report with NH Bureau of Elderly and Adult Service (BEAS).  

However, the requirement to report extends to incapacitated adults only. Phone number for BEAS is 1-800-949-0470. The report to BEAS is confidential.

Additional facts:

• According to a 2011 MetLife study of elder financial abuse, as much as $2.9 billion per year is stolen from seniors.
   
• NH is the 4th oldest state in the U.S.
   
• Population of NH residents age 65+ is expected to double by 2025

Gifting Considerations

Gifting can have serious consequences, in the event a person needs nursing home care and doesn't have enough funds to pay for his/her care for 5 years.

As we discussed in a previous post, there is a five (5) year disqualification period for Medicaid purposes for any improper transfer or gift. The question is what constitutes an improper transfer?

• Giving away assets for less than FMV unless such transfer is exempt under the rules; paying for your grandchild's education, your daughter's new car, and/or giving each of your children $14,000.00 for Christmas every year are all improper transfers
   
• Adding a child or another third party as a partial owner/owner of your property
   
• Selling assets for less than FMV; i.e., my car was worth $10,000.00, but I gave it to my grandson for $2,000.00
   
• Purchasing an annuity that doesn't comply with the Medicaid rules
   
• Paying a family member for services without a written contract
   
• Disclaiming assets from an inheritance

Unfortunately, the Medicaid system's holiday spirit can be more like Ebenezer Scrooge's. This being the case, if you are contemplating any "improper transfers" and there is any possibility that you or your spouse could need nursing home assistance down the road, it is important to contact your elder law attorney prior to doing so.

Changes to NH Advanced Directives

The New Hampshire legislation has enacted changes to advanced directives relating to medically administered nutrition and hydration. These changes became effective on January 1, 2014. 

The intent of the legislature was to clarify the definition of medically administered nutrition and hydration and include it under the definition of life sustaining treatment. 
                                      
Unfortunately, while life sustaining treatment is defined to include medically administered nutrition and hydration in the statute, medically administered nutrition and hydration is not included on the definition on the proposed new advanced directive form. Furthermore, the legislature inadvertently neglected to change the disclosure form which specifically states that if you want to give your health care agent the power to withhold or withdraw medically administered nutrition and hydration, you must say so in your directive. Otherwise, your health care agent will not be able to direct that. This is problematic since a question relating to medically administered nutrition and hydration does not exist on the new health care power of attorney.                                          To resolve these issues, it is thought that the legislature will be making further changes to the statute in its upcoming session. For these reasons, we have modified our advanced directives slightly, but until the legislature addresses the present ambiguity and conflict in the statute, our advanced directives still include a question that specifically addresses medically administered nutrition and hydration.                                            We will continue to keep you updated.

Caregiver Conversations?

Often holidays are a time when family and friends get together and this being the case, it can be a good time to initiate conversations with loved ones about difficult topics, one of which is end of life wishes.  

Encouraging your loved one, not only to speak to you, but to speak to all family members about his/her wishes so that everyone is on the same page can minimize your stress down the road.                                                                                                                           

Son Liable for Nursing Home Bill Under Filial Responsibility Law

A Pennsylvania appeals court recently found a son liable for his mother's $93,000 nursing home bill under the state's filial responsibility law.

His mother entered a nursing home for rehabilitation following a car accident. She later left the nursing home and moved out of the country, leaving a large portion of her bills unpaid. She filed an application for Medicaid, which is still pending.

The nursing home sued the son, under the state's filial support law, which requires a child to provide support for an indigent parent. The trial court entered a verdict in favor of the nursing home, despite the son's appeal arguing the court improperly put the burden of proving his inability to support his mother on him, and that the court should have considered alternate forms of payment such as Medicaid.

However, the verdict stood, as the Superior Court stated the law does not require the court to consider other sources of income or to stay its determination pending the resolution of a Medicaid claim.

Read full article...

Eliminating the Need for Improvement... Beneficial Changes for Some Medicare Patients

In our spring 2012 newsletter, we stated that nursing homes may mistakenly require a resident to be improving or showing progress in order to continue to be covered by Medicare. One may see an incorrect denial of further Medicare coverage if a resident plateaus, or if the nursing facility says the resident can no longer be rehabilitated.

Now, as recently reported in the New York Times, the Obama administration pursuant to a proposed settlement of a nationwide class-action suit, has agreed to scrap a practice that required many beneficiaries to show a likelihood of medical or functional improvement before Medicare would pay for skilled nursing and therapy services.

This agreement states that Medicare will now pay for such services if they are needed to "maintain the patient's current condition or prevent or slow further deterioration," regardless of whether the patient's condition is expected to improve.

Read the full article...

The Impact of Recent Elder Law Court Rulings

Earlier this year the Supreme Court upheld the Affordable Care Act, which by-and-large ensured the preservation and continued roll-out of improvements and protections for older adults.  

These improvements include the extension of Medicaid's spousal impoverishment protections to those seeking long-term care in the community, financial incentives for states to keep long-term care recipients out of institutions, the gradual closing of Medicare Part D's infamous doughnut hole, expanded access to preventive services for Medicare beneficiaries, and the Elder Justice Act.  

The Court did, however, scale back the Medicaid portion of the law, which could mean that fewer near-elderly will have access to health insurance than was originally envisioned. The law expanded Medicaid eligibility starting in 2014 to people with income up to 133 percent of the poverty line. But in its ruling, the Supreme Court gave states the freedom to opt out of this expansion without putting their current Medicaid funding at risk.

Naturally, these decisions will impact different people in different ways depending upon a number circumstances specific to each family's situation. To determine how your family might be affected, the safest course of action is to consult with your elder law attorney.