46 THE QUEENS COURIER • HEALTH • MARCH 1, 2018 FOR BREAKING NEWS VISIT WWW.QNS.COM
health
The Elder Law Minute TM
Can I Use the Money I Was Given for Medicaid Planning Purposes?
BY RONALD A. FATOULLAH, ESQ.
AND STACEY MESHNICK, ESQ.
Medicaid is a jointly funded, Federal-
ELDER LAW
New York State program which off ers
broad medical services to individuals
who are blind, aged (over 65), or disabled.
EMOTIONAL INTELLIGENCE AND LONG TERM CARE
Without question, working in long
term care is demanding and stressful. In
addition to the intrinsic stressors staff
must face daily in nursing homes, oft en
they must also struggle with managers
who add to the stress. It takes only one
thoughtless supervisor to create a work
environment that goes from bad to worse
in an instant.
Unfortunately there are managers and
supervisors in long term care who may
lack self-awareness or the desire to evolve
into better leaders. Th ey may intentionally
create “power distances” between
themselves and their employees. Th is
distance may also signal that they may be
unapproachable.
Nursing home owners, CEOs, corporate
executives, department heads and
charge nurses are all in positions of leadership
– positions that have a profound
eff ect on staff attitudes and the performance
that they convey to their residents.
When key staff lack knowledge of eff ective
personal management approaches, it
is impossible to cultivate a healthy and
productive work environment – the kind
of work environment so crucial to the
proper care and comfort of their residents.
Workplace stress invariably has a negative
eff ect on the emotional well-being
of employees. Th e one way to alleviate
stress in the nursing home environment
and ensure the quality of life for
the elderly residents, is for providers to
require that their executive management
and department heads evolve as leaders
and learn to manage the emotional needs
of the workforce, in addition to the operational
needs of the facility.
In Daniel Goleman’s book, Primal
Leadership: Realizing the Power of
Emotional Intelligence, he takes the core
position that great leadership is acquired
by infl uencing the emotions of those who
lead. In fact, the author posits that the
fundamental task of leaders is to prime
good feelings in those they lead and create
resonance, or a reservoir of positivity
that brings out the best in others.
Th e main premise behind the emotional
intelligence theory is that the essence
of any job, for any human being, is emotional.
An individual who is emotionally
bankrupt is simply not capable of
spreading a wealth of warmth, compassion,
nurturing, and tolerance on the job.
Th e greater a leader’s skill at transmitting
emotions, either positive or negative, the
more forcefully the emotions will transfer
to others. When leaders have the skill to
steer emotions in a positive direction, they
enable employees to transcend the mundane
aspects of a job and achieve their
best. Th is process is known as resonance.
It is management that sets the tone and
creates the atmosphere in every facility.
Negative, non-compassionate and
non-responsive managers create facilities
whose hallmarks and atmosphere
are conveyed in uncommunicative protocols,
etc.
As humans, we rely on connections
with others for our own emotional stability,
and when those connections are positive,
emotional stability is easier to sustain
and disseminate.
It is clear then, that the focus of all
organizations should never be about just
one leader, but rather about creating a
constituency of leaders throughout all
levels of that organization.
Th e emotional intelligence philosophy
strongly supports an environment
that cultivates emotional intelligence
throughout each level of that organization
in order to teach employees
how positive communication, cooperation
and collaboration, as well as having
empathy towards one another, can create
an inherently compassionate environment
for the residents, and their
co-workers. Remember: your facility is
who you are!
Quotable Quote: “It is not the strongest
among us who survive. Nor is it the
most intelligent. It is those among us
who are the most adaptable to change.”
Lisa Unger, Author
Sheldon Ornstein Ed.D, RN, LNHA
Dr. Sheldon Ornstein is a
registered professional nurse
with a doctoral degree in
nursing organization. He
has specialized in the care
of older adults and has
published many articles on
the subject. He has done
post-graduate work in gerontology
and has taught
at several universities. In
2013, he was inducted into
the Nursing Hall of Fame at
Teachers College, Columbia
University.
Most people, however, tend to
associate Medicaid with home health
care aides (Community Medicaid)
and nursing home care (Institutional
Medicaid).
In New York, to fi nancially qualify
for Medicaid individuals can own no
more than $15,150 in assets. If individuals
have assets exceeding this amount,
called the resource allowance, they
must divest themselves of the excess,
which ordinarily involves a transfer of
the applicant’s assets to someone else.
While some transfers are permitted by
Medicaid without a penalty, including,
for example, transfers to spouses and
disabled children, most other transfers
are not.
For Institutional Medicaid there is
a fi ve-year look back period whereby
Medicaid reviews the applicant’s fi nancial
statements for the fi ve-year period
preceding the application. Th e purpose
of this review is to identify any non-exempt
transfers of assets, which, if any,
will create a period of ineligibility. For
example, for individuals living in New
York City, every $12,319 they transfer
will create a one-month period of ineligibility.
If applicants are unable to utilize
exempt transfers, they can choose
either to privately pay a nursing facility
until such time as they fall below
the resource allowance or to engage in
what has been commonly referred to
as promissory-note planning. In the
promissory-note plan, the applicant
transfers a portion of his or her assets,
roughly one-half (1/2), which transfer
is a gift . Th is gift creates a period of
ineligibility. Th e remaining portion of
the applicant’s assets is loaned to the
same individual, which funds are used
to pay for the applicant’s nursing home
care during the period of ineligibility
caused by the gift . At the expiration of
the penalty period, concurring with the
repayment of the loan, the applicant
becomes eligible for Medicaid.
A question that oft en arises in promissory
note planning is whether the
gift portion really is a gift . In other
words, can the gift be spent by the
recipient? Th e simple answer is yes,
but any experienced elder law attorney
will advise against spending the gift , at
least temporarily. Th is is because when
the promissory-note plan is submitted
to Medicaid along with the Medicaid
application, it may take months to
receive the plan’s approval. If, however,
the plan needs to be recalculated
because, for instance, the applicant
forgot to identify a particular asset or
forgot to recall a particular gift made
in the past fi ve years, a portion of the
gift ed asset may have to be returned
to the applicant. If the gift ed money is
unavailable because it was spent, the
applicant’s Medicaid eligibility may be
placed in peril.
A promissory-note plan, when properly
prepared, is an extremely useful
way to preserve a portion of an applicant’s
assets while qualifying for nursing
home Medicaid. Th e plan, however,
is also very complex. It is therefore recommended
that applicants desiring to
use a promissory-note plan in connection
with nursing home Medicaid seek
the services of an experienced elder law
attorney.
Ronald A. Fatoullah, Esq. is the principal
of Ronald Fatoullah & Associates,
a law fi rm that concentrates in elder
law, estate planning, Medicaid planning,
guardianships, estate administration,
trusts, wills, and real estate.
Jeff rey P. Gorak is an elder law attorney
with the fi rm. Th e law fi rm can
be reached at 718-261-1700, 516-466-
4422, or toll free at 1-877-ELDER-LAW
or 1-877-ESTATES. Mr. Fatoullah is
also a partner with Advice Period, a
wealth management fi rm, and he can be
reached at 424-256-7273.
RONALD FATOULLAH
ESQ, CELA*