Elder Needs Archives - Vickstrom Law

Medicaid (MassHealth) Nursing Home Planning in Massachusetts

June 1, 2026 by lawclerk

The cost of nursing home care in Massachusetts can drain a lifetime of savings far faster than most families expect. That is why Medicaid nursing home planning in Massachusetts is not just a financial issue – it is a legal and family protection issue that often needs attention before a crisis begins.

Many people use the terms Medicaid and MassHealth interchangeably, and in Massachusetts, MassHealth is the Medicaid program that may help cover long-term nursing home care for eligible individuals. The challenge is that eligibility is based on strict financial and medical rules. Families are often surprised to learn that a parent may need care now, but qualifying for benefits is tied to income, assets, prior transfers, and documentation.

What Medicaid (MassHealth) nursing home planning in Massachusetts really involves

At its core, Medicaid nursing home planning in Massachusetts means preparing for the possibility that nursing home care may be needed and taking appropriate steps to protect as much of a person’s finances and property as possible. That can include reviewing countable assets, understanding which resources may be exempt, planning for a spouse who remains at home, and avoiding mistakes that can delay approval and cost families tens of thousands.

This is not a one-size-fits-all process. A married couple in Worcester may have very different planning options than a single applicant. The right strategy often depends on health, timing, family support, the type of assets involved, and whether care is needed immediately or may be needed in the future.

Why families get caught off guard

One of the biggest misconceptions is that Medicare will pay for long-term nursing home care indefinitely. Medicare does not pay for long-term nursing home care . Medicare coverage is limited and typically tied to short-term skilled care after a qualifying hospital stay. When someone needs ongoing custodial care, families often have to look to private funds or Medicaid (MassHealth).

Another common mistake is giving away money or transferring a home without understanding the five-year look-back period. Certain transfers for less than fair market value can create a penalty period that delays eligibility. A well-meant gift to children or grandchildren may create a serious problem if nursing home care becomes necessary sooner than expected.

Key legal and financial issues to review

A good planning review starts with a clear inventory of assets, income, and legal documents. Bank accounts, retirement funds, real estate, life insurance, and existing trusts all need to be evaluated carefully. So do powers of attorney, because if the right authority is not in place, a family may have trouble taking action when a loved one becomes incapacitated.

For married couples, preserving financial stability for the spouse living at home is often a central concern. Massachusetts rules may allow the community spouse to retain certain income and assets, but the calculations matter. Small errors in how accounts are titled, spent down, or disclosed can affect eligibility and create unnecessary stress.

The home also raises important questions. In some situations, a primary residence may be treated differently from other assets for eligibility purposes. That does not mean the home is automatically protected in every case. Estate recovery rules, ownership structure, and future planning goals all need to be considered together.

Planning before a crisis versus during a crisis

Advance planning usually creates more options. When families plan early, they may be able to use trusts, asset repositioning strategies, and updated incapacity documents to reduce future risk and improve flexibility. Early planning also gives families time to make decisions thoughtfully instead of reacting under pressure.

Crisis planning is different, but it is still often possible. If a loved one is already in a nursing home or is expected to enter one soon, there may still be legal strategies available to preserve some assets and move toward MassHealth eligibility. The options are narrower, and timing becomes more urgent, but late planning is not the same as no planning. The five year look-back period does not apply to last minute planning strategies for Medicaid (MassHealth) nursing home long-term care planning.

Why Massachusetts-specific guidance matters

MassHealth rules are technical, and the application process can be document-heavy with thousands of pages ultimately being included with the MassHealth (Medicaid) application. Families may need to produce years of financial records, explain transfers, verify income sources, and respond to agency requests within deadlines. Even when the basic goal seems simple, the details can become overwhelming and time consuming quickly.

Massachusetts residents also need to account for state-specific practices, local property issues, and probate and estate recovery concerns that may not be obvious from general online information. What worked for a friend or relative may not apply to your specific situation.

For that reason, many families benefit from working with an elder law attorney who can help them understand their options before making transfers, signing nursing home paperwork, or spending down assets in ways that cannot be reversed. At Vickstrom Law, PC, this type of planning is approached with the understanding that families are often dealing with both emotional strain and financial uncertainty at the same time.

The best first step is usually not rushing into a transfer or assuming there is no way to protect anything. It is getting clear advice based on the person’s health, assets, family situation, and timing. With the right guidance, nursing home planning can become more manageable, and families can make decisions with greater confidence.

Telemarketing Fraud: Steps to Protect Elders

June 2, 2018 by Kristina

Elder abuse comes in many forms. An overwhelming majority of it is financial abuse. If you have an elder parent or family member who lives alone, he or she may be at risk of a new wave of telemarketing fraud targeting the elderly.

One recent case of telemarketing fraud billed elderly consumers for medical alert devices they never ordered. Telemarketers would claim they were calling in response to a request for information from the person or a family member and then try to sell them the device. Even those who didn’t order were sent a bill along with the shipment. The company behind the telemarketing fraud would then use threats and intimidation to induce the victims to pay.

If you don’t think telemarketing fraud can happen to your loved one, consider this. According to a study by the AARP, seniors over age 50 are disproportionately at risk for becoming victims of telemarketing fraud. The study found that the average age of victims was 69 and that women were twice as likely as men to become victims.

Telemarketing fraud is also becoming increasingly sophisticated. Fast-talking predators use high pressure sales techniques and psychological ploys to overcome a senior’s initial resistance. Some other common schemes involve low-cost, high-risk investments, fake charities, time-sensitive product deals, or prize winnings that seniors are told they have to pay taxes or a fee to collect.

When a senior becomes a victim of telemarketing fraud, it can be financially devastating. Because these crimes are hard to trace, it is very difficult for victims to get their money back. Sadly, many incidents of telemarketing fraud against the elderly simply go unreported. Elderly victims may be embarrassed, don’t know where to go to report the crime, or fear they will lose their independence if they do report it.

Here are some steps you can take to help protect your elderly parents or family members from becoming victims.

Talk to your parents about types of telemarketing fraud and remind them never to pay up front for a product or service, or to give out personal information such as a credit card or social security number over the phone.

Offer to help them manage their personal finances so you can monitor bank and credit card statements for any unusual activity.

Have them sign up for national Do Not Call list (888-382-1222, www.donotcall.gov) to help cut down on telemarketing calls.

Design a call script, such as “I don’t give out personal information over the phone,” to aid them in ending calls from pushy telemarketers.

If your elderly parent has dementia, or is otherwise incapacitated, you may want to contact an elder law attorney to advise you on utilizing your parent’s durable power of attorney and/or obtaining a guardianship or conservatorship.

For more suggestions on how to identify and prevent elderly telemarketing scams, visit the Federal Trade Commission’s consumer education website.

The best protection against telemarketing fraud and elder abuse is to ensure that your loved ones are properly cared for and that their assets are protected. Proper estate planning can help give you and your loved ones piece of mind. Contact us to discuss various planning options today.

Photo Credit: Tim Dorr

How to Choose the Best Medicare Part D Drug Plan

October 11, 2013 by Kristina

Choosing the best drug plan under Medicare Part D isn’t always easy. Some people just pick the plan with the lowest premium, but that Medicare Part D plan might not be the best value for you, depending on your needs.

The real cost of a Medicare Part D plan depends not only on the premium, but also on the availability of the drugs you need, your additional out-of-pocket costs, and how convenient it is to obtain your medications. [Read more…]

Settlement Over the Medicare Improvement Standard Will Improve Coverage for Some

February 11, 2013 by Kristina

If you, or a loved one, depend on Medicare for ongoing care of a chronic or degenerative disease, you may be familiar with the Medicare Improvement Standard.

Medicare is health national insurance for people over age 65, the disabled, or those with end stage renal disease. For decades, the Medicare Improvement Standard meant that coverage for physical, occupational and speech therapy and some inpatient skilled nursing was denied by contractors processing claims for many people who had reached a plateau in their treatment, that is to say, for those who were not improving.

Medicare is supposed to pay for reasonable treatment as long as a doctor has prescribed it. For in-home care, a doctor must have certified that you are, in fact, homebound and have prescribed treatment that only a skilled practitioner can provide. This “skilled practitioner rule” keeps Medicare from paying for assistance with everyday activities like bathing and dressing.

Consider the case of Glenda, she is 76 and rendered disabled by diabetes. She is both blind and has suffered amputation of a leg and several toes. She was the lead plaintiff in the case that led to the settlement, and under the Medicare Improvement Standard, had been denied coverage of the skilled care she needed due to the fact that her condition was chronic and did not improve. This unofficial policy has been frustrating to many. It is often painfully obvious that those suffering chronic or degenerative diseases will not and cannot improve. But, the kind of skilled care covered by the Medicare Improvement Standard settlement can stabilize or slow the progression of such diseases. These patients can now prevent painful and costly complications.

The Medicare Improvement Standard settlement requires the Centers for Medicare and Medicaid Services to clarify to their contractors that home and nursing home therapy and nursing services for Medicare beneficiaries are not dependent “on the presence or absence of a beneficiary’s potential for improvement from the therapy (and nursing care), but rather on the beneficiary’s need for skilled care.” This language also pertains to outpatient therapy services. This clarified policy is know as the “maintenance coverage standard.”

The Center for Medicare Advocacy, co-counsel for the Plaintiffs, stresses that the new standard applies now, and that Medicare patients denied coverage under the old “medicare improvement standard” should advocate for themselves and appeal those denials.

It is important to remember that this Medicare Improvement Standard settlement does not affect the need for long-term care planning. Without careful planning you may still have to pay for years in a nursing home when you can no longer handle basic tasks of daily living and staying in your home is no longer practical.

If you, or a loved one, would like more information about long-term care planning contact us. Proficient in Estate Planning, Elder Law and Long-Term Care/Medicaid (MassHealth) Planning, Attorney Kristina Vickstrom can help you understand your rights and any remedies that may be available to you.

Massachusetts Question 2: Assisted Suicide. What You Need to Know for Election Day

October 26, 2012 by Kristina Vickstrom, Esq.

We’re not only voting for the next President and a Senator from Massachusetts in November, but on a battery of ballot questions. Ballot Question 2 is one of the more controversial. The so-called “Death with Dignity” or “Right to Die” legislation would allow an adult resident who is (1) capable of making and communicating health care decisions, (2) diagnosed with an incurable and irreversible disease that will cause death within six months, and (3) voluntarily, and in an informed manner, so decides to obtain a prescription for medication to end his or her life. You can read the proposed legislation here.

Oregon and Washington state already have similar legislation in place. In Oregon, most candidates are well educated cancer sufferers over the age of 65, who died at home and were enrolled in hospice care. This “typical candidate” is familiar to many of us working with elders. Maybe it is because so many of us know or have known someone like this that the “Right to Die” issue has strong voices on either side. [Read more…]

Some Seniors are Losing Their Homes Due to Unpaid Property Taxes

October 2, 2012 by Kristina Vickstrom, Esq.

An 81-year-old woman in Rhode Island was evicted shortly before Christmas from the home she had lived in for more than 40 years – because she failed to pay a $474 sewer bill. A corporation then bought her house at a tax sale for $836.39…and later resold it for $85,000. While this is an extreme case, it’s a symptom of a growing trend. More and more seniors around the country are being forced to pay large, unnecessary fees – or even losing their homes – as a result of unpaid property taxes.

Because property taxes aren’t regular monthly expenses like utility or cable bills, they’re often among the first things that seniors overlook if they begin to have some difficulty managing their own affairs. And they’re frequently missed by children and caretakers as well. Also, many older people who have recently finished paying off a mortgage aren’t used to paying their property tax bills, because for decades they were paid directly by the lender. [Read more…]

Many Power of Attorney and Health Care Proxy Documents Should be Revised in Massachusetts

May 17, 2012 by 3mediaweb

If you’ve had legal documents drafted in Massachusetts pertaining to your health, financial, and long-term care wishes, you should have them reviewed and revised now! Massachusetts laws relating to powers of attorney and health care proxies have recently changed. This along with federal medical privacy laws can affect your already-created documents.

The federal law, known as the Health Insurance Portability and Accountability Act (HIPAA), generally prevents health care providers from disclosing your personal medical information to anyone other than you and someone you’ve named as your “personal representative.” Frequently you will sign medical releases at your physician’s office allowing them to communicate with any specialists you are seeing, like a podiatrist or a cardiologist. Protecting your medical privacy is very important but the law can create some complications. [Read more…]

How Do I Bring Up the Topic of Estate Planning to My Parents?

December 27, 2011 by Kristina Vickstrom, Esq.

In Worcester, just as everywhere else in the nation, there is a tendency for people to put off estate planning. Elder law attorneys, like Kristina Vickstrom, recognize that there are multiple factors that lead people to procrastinate when it comes to the estate planning process. [Read more…]

I Take Care of My Mother. Can I Legally Get Paid for That?

November 30, 2011 by Kristina Vickstrom, Esq.

As the number of family members providing care for aging parents increases, the solutions to find help with loss of income because of time off from employment for caregiving has become a major concern for many. The demands on both the time and energy needed to provide the needed care can make it impossible to maintain both a full time job with full time caregiving. [Read more…]

The Difference Between Alzheimer’s Disease and Dementia

October 13, 2011 by Kristina Vickstrom, Esq.

Many people use the terms Alzheimer’s disease and dementia interchangeably, but they have very different meanings. Although dementia is a group of symptoms that include memory loss, the term itself doesn’t explain what is causing the symptoms. Alzheimer’s disease is the leading cause of dementia, but there are many other causes. [Read more…]