ELDER
LAW
2006 Update by:
Susan Dishler Shubin, Esq.
Legal Aid Bureau, Inc.
Towson, Maryland
Original Text by:
Luther Blackiston, Esq.
Susan Dishler Shubin, Esq.
Legal Aid Bureau, Inc.
Towson, Maryland
This book is dedicated to the memory of the late Luther
Blackiston,
a giant of elder law for low-income seniors.
Table of Contents
I. INTRODUCTION ............................................................... 7
II. ETHICAL CONSIDERATIONS ....................................... 7
III. ESTATE PLANNING ........................................................ 9
IV. MANAGING PROPERTY AND INCOME ...................... 9
A. Inter Vivos Transfers of Property ................................. 9
B. Powers of Attorney .................................................... 10
1. Competence ....................................................... 10
2. Fiduciary duties .................................................. 11
C. Guardianship ............................................................. 11
D. Substitute Payees ..................................................... 12
V. DEATH WITH DIGNITY — HEALTH CARE
DECISIONS ...................................................................... 12
A. Health Care Decisions .............................................. 12
1. Guardianship law ................................................ 12
2. Health Care Decisions Act ................................. 13
B. Suicide ....................................................................... 16
VI. ABUSE AND EXPLOITATION ..................................... 16
VII. HOME EQUITY
CONVERSION — REVERSE
MORTGAGES .................................................................. 18
VIII. PAYING FOR
HEALTH CARE ..................................... 19
A. Private Insurance ....................................................... 19
B. Routine Medical Care and Prescription Drug
Coverage ................................................................... 20
1. Routine Medical Care ......................................... 20
2. Prescription Drug Coverage .............................. 20
C. Original Medicare and Medicare Advantage .............. 22
D. Hospital Care & Medicare Part A ............................... 22
E. Medicare Part B ......................................................... 22
F. Medicare — Nursing Home Care .............................. 23
G. Medicare — Home Health Care and Hospice
Care .. 24
IX. MEDICAID IN MARYLAND — MEDICAL
ASSISTANCE .................................................................. 25
A. Introduction ................................................................ 25
B. QMB and SLMB ......................................................... 25
C. Program Basics ........................................................ 26
D. Eligibility and Coverage Rules ................................... 28
1. Community medical assistance ........................ 28
a. Eligibility ........................................................ 28
b. Non-financial eligibility rules ......................... 28
c. Income eligibility ........................................... 28
d. Asset eligibility .............................................. 29
2. Medical assistance — Long-term care .............. 30
a. Medical eligibility — Nursing home
level of care .................................................. 31
b. Income eligibility ........................................... 32
c. Spousal allowance ....................................... 33
d. Assets .......................................................... 34
e. Disposal of assets (transfer of assets) ....... 38
f. Liens ............................................................. 39
g. Other unavailable assets issues .................. 39
X. NURSING HOME RESIDENTS’ RIGHTS .................. 40
A. Overview — The Interplay Between State and
Federal Laws ............................................................. 40
1. Maryland law ....................................................... 40
2. Federal law ......................................................... 41
B. Nursing Home Residents’ Rights .............................. 42
1. Admission and discharge ................................... 42
a. Discrimination .............................................. 42
b. PASARR — Pre-admission screening and
annual resident review ................................. 43
c. Admission contracts .................................... 45