Nursing Home Admissions Contract and Power of Attorney

Maryland nursing homes make use of two alternative model form nursing home admissions contracts approved by the Maryland Department of Health. These are the model Financial Agent’s Resident Agreement and the model Resident’s Agreement.

Maryland also has a power of attorney statute which includes form powers of attorney, among the provisions of which empower an agent under power of attorney to act for the principal to enter into contracts on behalf of the principal.

In light of the two factors addressed above, it is within the realm of possibility and legally permissible for an adult child of a person entering a nursing home who is acting as the agent under a power of attorney created by the parent entering the nursing home to execute a Resident’s agreement on behalf of the parent.

Nevertheless, when a parent enters a nursing home, the nursing home usually presents to such agent under a power of attorney the Financial Agent’s Resident Agreement to secure admission to the nursing home. Often this is done after the parent actually enters the nursing home.

William M. Gatesman strongly advises clients not to have their their agents under power of attorney sign the Financial Agent’s Resident Agreement, but rather, to sign, as agent under power of attorney, the Resident Agreement. Nevertheless, some nursing homes will refuse to provide such Resident Agreement to the agent to sign.

The problem with the Financial Agent’s Resident Agreement is that, technically, it is not legally the act of the agent under power of attorney binding the parent to a contract. Rather, it is a contract that binds the agent under power of attorney, typically an adult child of the person entering the nursing home, to a contract, making the agent legally and financially responsible to take certain actions not otherwise mandated by the agency relationship arising out of a power of attorney.

Indeed, the typical nursing home Financial Agent’s Resident Agreement contains a laundry list of matters for which the person signing the agreement binds themselves to the risk of suffering fines and civil money penalties of up to $10,000, and some of these provisions might be triggered when events occur that are not in the direct control of the agent signing the Financial Agent’s Resident Agreement.

Moreover, while the law offers opportunities for an agent under a power of attorney to facilitate and fulfill the estate plan of the person entering the nursing home by engaging in asset preservation planning strategies to facilitate Medicaid eligibility while still preserving assets, if an agent engages in such planning after signing a Financial Agent’s Resident Agreement, then such person will have made themselves subject to at least one of the circumstances that gives rise to such $10,000 penalties addressed in the foregoing paragraph, not to mention other potential personal liability.

In cases where the person entering the nursing home does not have a power of attorney, the Financial Agent’s Resident Agreement contains provisions that allow for an adult child of the person entering the nursing home to sign such agreement and to bind such child to the provisions of such agreement even if such adult child does not hold a power of attorney from the parent. The same issues addressed above pertain to any such adult child who signs a Financial Agent’s Resident Agreement.

William M. Gatesman urges any person involved in the admission of a parent or other loved one into a nursing home, if such person is asked to sign an admissions agreement with the nursing home on behalf of such person, to obtain competent legal advice before signing such agreement.

Indeed, Mr. Gatesman, has advised numerous clients not to sign the Financial Agent’s Resident Agreement, or to do so only after it has been modified by Mr. Gatesman to protect the person signing such contract.

William M. Gatesman stands ready to assist clients in the legal processes relating to nursing home admissions, including addressing the questions relating to which is the appropriate nursing home admissions contract to sign and how to protect the person signing such contract from the risk of personal liability.

Ageism and the Right to Drive

A client called me recently to report that the Maryland Department of Motor Vehicles had suspended his license for medical reasons. The MVA notice was deficient in that it did not give particular details as to the reason for the suspension.

Only later did we learn that a physician who my client had visited only once sent in a one line report stating that the client had dementia and memory issues and should not be allowed to drive.

We appealed the MVA license suspension and, in support of our appeal, we submitted letters from my client’s doctor who has a five year history with the client and a physchiatrist who has a 13 year history with the client, both of whom opined that the client, while he did experience mild dementia, was not so impaired as to be unable to drive safely.

We won that appeal and my client’s right to drive has been restored.

This case reveals that ageism may play a role in some doctors’ perceptions of an older person, and may color the doctor’s judgments about a patient’s abilities.

Fortunately, the law provides a remedy for persons whose right to drive is improperly denied due to the rash actions of those who do not take into account all of the factors impacting a patient’s ability to drive. In a word, the law enables older people to combat ageism.

William M. Gatesman assists seniors and their family members in addressing legal issues that impact them. If you encounter such a problem, you may call Mr. Gatesman at 301-260-0095 to learn whether there is a solution available to you.

Supported Decision Making

Supported Decision Making is a new concept gaining favor in the community of people working to better the lives of people with disabilities. There is no formal process or formal legal recognition of Supported Decision Making in Maryland and it is a developing area of law in only a few states and other jurisdictions. The District of Columbia, for example, does give some recognition to Supported Decision Making in its statutory law.

Supported Decision Making typically would involve a person with limited personal capacity agreeing and communicating to other parties that such person wishes to have another trusted individual involved with communications with third parties such as banks, medical care providers, and so on, and that such person wishes to obtain the trusted individual’s input and guidance. Nevertheless, the person with limited capacity retains the right to make all her decisions.

Supported Decision Making often is implemented by means of a Supported Decision Making agreement or other legal document memorializing the relationship between individuals that could be presented to third parties for the purpose of enabling the trusted person to be involved with communications between the third party and the person of limited capacity. Such document serves the purpose of notifying third parties of the trusted person’s advisory role and can be used to open doors to enable the trusted person to participate in conferences which usually are attended only by the person of limited capacity and the third party. In states such as Maryland in which Supported Decision Making is not formally recognized in the law, the efficacy of such Supported Decision Making document is hard to predict, and any use of such tool in Maryland would be based upon a contractual relationship between the parties rather than upon specific statutory law.

A power of attorney, unlike the supported decision making agreement, establishes a legal relationship recognized under state law in which the person of limited capacity empowers the trusted individual to act in her place, as her agent. An agent under power of attorney (i.e. the trusted person) always is subsidiary and subservient to the principal (the person with limited capacity). With a power of attorney, the agent typically would be able to act alone even if the principal is not present or not personally involved in the interactions with the third party. Power of Attorney has been recognized by the law for a very long time and there would be no question as to the validity of the relationship of the principal and the agent.

A Supported Decision Making arrangement may be beneficial in some circumstances to provide a person with limited capacity a greater sense of autonomy and control while still enabling the trusted individual to be involved with her affairs and it could open doors to allow the trusted individual to be involved in situations in which privacy laws or other restrictions otherwise may keep the trusted individual on the sidelines. The person with limited capacity may desire to appoint the trusted person as her agent under power of attorney, as well, so that if the person with limited capacity became unable to manage her affairs, then the trusted person would have the authority to act on her behalf.

William M. Gatesman stands ready to assist clients who may have heard about Supported Decision Making and would like to learn more about it or who think that Supported Decision Making is a tool they may wish to employ in their estate planning.

Degrees of Relationship

Have you ever referred to someone as being your “second cousin?” Would you be surprised if you may have gotten the relationship wrong? Posted below is the Nolan Chart of Relationships and Degrees of Kindred. This chart, while it is interesting from a familial relationship point of view, also provides legally significant information that is important in some instances when administering a decedent’s estate.

Medicaid Planning with Augmented Estate

There is a new law in Maryland that, effective October, 2020, will allow a surviving spouse to elect to take a portion of property passing as a consequence of a spouse’s death under an augmented estate formula. What does this mean?

Before the new law, a spouse only could elect to take a portion (one-third or one-half depending on the circumstances) of the estate that passed through probate. Lawyers who assist clients with Medicaid asset preservation planning took advantage of that by assisting couples to preserve all of their assets when one of the married couple needed nursing home care. The plan worked like this (and until October, 2020, will still work like this): If Husband is in a nursing home and Medicaid is paying for all of his care, then Wife could arrange to have all the assets to be titled in her name and pass outside of a probate estate.

Tools one may use to pass property outside of probate are bank and investment accounts that are designated “Pay on Death,” beneficiary designations, and life estate deeds. Before the new law takes effect next year, property passing by such tools will not be subject to an elective share by a surviving spouse.

That being the case, a husband and wife could set up their estate planning so that, if one them needs nursing home care in a nursing home for which Medicaid is paying the bill, and the spouse at home dies first, all of the couple’s assets could be protected rather than having those assets pass to the spouse in the nursing home causing Medicaid ineligibility.

Under the new augmented estate rules, however, all property held by the spouse at home would be subject to the elective share. Hence, in a case where Husband is in a nursing home and Medicaid is paying for all of his care, if Wife dies first, then it would appear at first blush that she no longer could shelter assets with”Pay on Death” accounts, beneficiary designations, and life estate deeds, because, under an augmented estate law, all of those assets are available for the spouse to elect to receive a portion.

Such is not the case with the Spousal Protection Wills that I have been using to do Medicaid planning for married couples, however. If a married couple employs the Spousal Protection Wills that I recommend, coupled with “Pay on Death” accounts, beneficiary designations, and life estate deeds that direct assets to the trust under the Will of the deceased spouse at home, which Spousal Protection Trust is for the benefit of the Husband in the nursing home in the example discussed above, then, under the new augmented estate law, the spouse in the nursing home only would be able to elect to take 11% of the property.

That being the case, if Husband is in a nursing home, and Husband and Wife own property (including the value of the house) worth $600,000, then, if Wife dies first, only $66,666 would have to be paid to the Husband in the nursing home under the new augmented estate legislation. Indeed, the administrators of the Medicaid program will insist that the spouse in the nursing home elect to take the spousal share or risk losing Medicaid benefits.

In this way, even after October, 2020, a married couple with $600,000 worth of assets, following a Medicaid asset preservation plan facilitated by this office, can preserve $533,334 even if the spouse at home dies before the spouse in the nursing home.

But doing a Medicaid asset preservation plan with this office would not stop at preserving all but 11%. There still are ways to protect all of the assets even under the new augmented estate law. That law provides other levers one could pull to effectively preserve all of the assets, just like a married couple can do now under current law. Those levers include: (i) spousal consent when the plan is put in place, (ii) judicial review under which a court may take into account, among other things, the degree to which the estate planning arrangement provides a benefit to the surviving spouse in the nursing home (which surviving spouse would be the beneficiary of 100% of the assets when using a Spousal Protection Trust), and, (iii) when an agent under a power of attorney or guardian must exercise the spousal election to comply with the Medicaid rules after the spouse at home dies, there is a mechanism by which a court order may be obtained to recognize that the interests of the spouse in the nursing home are much better served when he remains the beneficiary of 100% of the couple’s assets (albeit as beneficiary of a trust) as opposed to taking only 11% of those assets and losing Medicaid benefits for a period of time as a consequence of doing so.

William M. Gatesman has studied the new augmented estate statute well in advance of its October, 2020, effective date, and already is adjusting the estate plans for new clients to prepare for future asset preservation planning.

If you wish to review your estate plan with these thoughts in mind, please call us at 301-260-0095.

Resolving Trust Matters Without a Court

Until recently, resolving issues relating to trusts where the governing instrument of the trust was silent concerning the matter was a complicated process. Generally, clients had to petition a court to interpret confusing terms in a trust, or to modify a trust, or to change a Trustee if no successor Trustee was named, or to do other things not spelled out in the trust agreement.

Since Maryland adopted the Maryland Trust Act, however, Trustees and beneficiaries can resolve matters without having to go to court. There are a number of statutory provisions that apply, including Estates and Trusts Code Section 14.5-111 which allows interested persons to enter into non-judicial settlement agreements.

A non-judicial settlement agreement may even be useful in cases where clients are unable to locate the trust document itself. Indeed, there are circumstances in which a non-judicial settlement agreement may be used to recreate the lost trust document so that property held in a trust bank account can be dealt with without the necessity of going to court, thereby saving clients time and money.

William M. Gatesman has worked with numerous clients to assist them in resolving trust problems by means of non-judicial settlement agreements.

Praise from an Old Client

I recently received the correspondence below.

Dear Mr. Gatesman,

I just wanted to reach out to you to  thank you for a case you worked on and won for my fiance, Althea’s mother, Beatrice, in about 2005

Beatrice was the widowed, unmarried partner of a man who died intestate in DC in 2004. I can’t remember the exact ownership of the real estate they held together , but it was not the typical joint, with survivorship held by most married couples.

Anyway, my fiancé and I are Long Term Care executives, and had previously encountered another elder law lawyer (on the opposite side of the bench) and found him to be a worthy opponent. So, when this situation arose I told my fiance to call the other lawyer, who was either unavailable or didn’t do real estate cases in DC. Anyway, what a stroke of luck for us that the other lawyer referred us to you to be our counsel!

I remember Althea telling me that you listened to the case details and remembered a similar case decided in 1924 in favor of the unmarried survivor widow, I think it may have been Campbell v District of Columbia.

So, it turned out Beatrice was the rightful owner of the real estate due to how the ownership was structured. She lived until her death in 2014 in the house. Her ability to live out her years in her home was due to your capable and competent representation. I remember Althea and I spoke to several 5 star DC Martindale lawyers at the time in 2005, and none of them gave us any encouragement about her retaining her home in the estate battle.

So , Mr. Gatesman, after all these years I wanted to reach out to you to thank you for your capable representation of Beatrice, who would likely have lost her home and been quite destitute but for your advocacy and representation.

Thank you for helping us get through that difficult period and helping Beatrice retain ownership of her home.

Appointing a Successor Trustee when the Trustee Dies

The governing documents for trusts often designate who will serve as successor Trustee if the office of Trustee becomes vacant. However, sometimes the trust documents are silent concerning this issue, or sometimes none of the designated successors are able to fill a vacancy in the office of Trustee. What can you do in such a circumstance?

In the past, the only recourse a trust beneficiary had was to incur the time and expense of obtaining a court order to appoint a new Trustee. Now however, under Maryland’s recently new Trust Code, beneficiaries can take action to install a successor Trustee without going to court.

In order to do so, the law requires the beneficiary to identify all of the “qualified beneficiaries,” which includes beneficiaries currently eligible to receive income and/or principal distributions, and those who would be able to receive such amounts if the current beneficiaries cease to be eligible.

One provision of the Maryland Trust Code allows for appointment of a successor Trustee by unaimous agreement of the qualified beneficiaries. Another provision allows for persons who have an interest in the trust to enter into a non-judicial settlement agreement, which agreement, among other things, can provide for the appointment of a successor Trustee.

While these avenues of appointing a Trustee are less onerous than having to petition a court, it still is important that one follow all of the procedures set forth in the relevant statutes.

William M. Gatesman works with clients to appoint successor Trustees using these streamlined non-judicial methods, thereby enabling such clients to save time and money.

Funeral Services on a Budget

While many people take into consideration social or religious considerations when choosing what funeral services to utilize, and such considerations may preclude those from seeking out cremation services, there are others who do not take those considerations into account and desire to know what inexpensive services exist for dealing with one’s bodily remains after death. One such service provider in Maryland and surrounding areas is the Going Home Cremation Service, the website for which company is http://www.goinghomecremation.com/.

Obtaining Medicaid for Prior Month’s Nursing Home Costs

William M. Gatesman frequently assists clients or their families to obtain Medicaid benefits to cover the long term care costs in a nursing home. In order to qualify for such benefits, the nursing home resident must meet certain medical and financial eligibility requirements, and Mr. Gatesman helps clients to meet those requirements. Often, the strategies employed allow for maximum asset preservation, allowing spouses or families to retain accumulated wealth while still qualifying for Medicaid benefits.

Sometimes, an individual has outstanding unpaid nursing home costs, or other unpaid medical bills, when they finally take action to satisfy the Medicaid eligibility requirements. Fortunately, the law allows for reimbursement for such pre-eligibility medical expenses through the Medicaid program.

That being the case, sometimes the best strategy is to refrain from paying an outstanding nursing home bill in order to qualify for Medicaid, and instead to make a payment that will be more beneficial, such as prepaying funeral and burial costs. Then, when a Medicaid application is filed, the applicant can request that such unpaid nursing home costs be paid with Medicaid dollars.

There are certain restrictions and there is a particular approach one must take in order to secure Medicaid coverage for past due medical bills. William M. Gatesman assists clients in obtaining this benefit which is a benefit over and above securing Medicaid benefits to pay current nursing home costs.

To learn more, you may call William M. Gatesman at 301-260-0095 to find out if you or loved one can benefit from this additional payment option.