AGE DISCRIMINATION
This plan provides pharmaceutical assistance to New Jersey residents whose income is too high for PAAD, but is not enough to adequately cover their prescription expenses each year.
64. What is the HAAAD program(Hearing Aid Assistance to the Aged and Disabled)?
This program provides a $100 reimbursement to eligible persons who purchase a hearing aid.
65. What is the ECO program (Enhanced Community Options)?
This program offers several care alternatives to individuals who would otherwise qualify for placement in a nursing facility. The decisions involved in providing care to an elderly loved one can be confusing and overwhelming. Through ECO, the Caregiver Assistance Program (CAP) provides in-home services to an eligible New Jersey resident that supplement the services provided by the resident's family and friends.
66. What is the CCPED program (Community Care Program for the Elderly and Disabled)?
This program is a statewide program designed to help individuals remain in, or return to, their communities by providing a variety of support services. Eight services are available under CCPED. The services include case management, home health, homemaker, medical day care, non-emergency medical transportation, respite care, social day care and prescribed drugs.
67. What is the Lifeline (Utility Assistance Program)?
This program offers $225 to persons who meet the PAAD eligibility requirements. This includes utility customers as well as tenants whose utility bills are included in their rent. Only one tenant in a household is entitled to this assistance. You are eligible for the Lifeline benefit if you are a recipient of PAAD.
68. What is the JACC program (Jersey Assistance for Community Caregiving)?
This program provides a broad array of in-home services and supports that enable an individual who would otherwise qualify for placement in a nursing facility to remain in his or her community home. By providing a uniquely designed package of supports for the individual, JACC is intended to supplement and strengthen the capacity of caregivers, as well as to delay or prevent placement in a nursing facility. JACC serves individuals who are not eligible for Medicaid or Medicaid waiver services, and participants will share in the cost of their services.
You should contact your county board of social services to determine whether or not you are eligible for any of the Medicaid programs.
An important Medicaid program is Medicaid Only. If you or a spouse have to enter a nursing home to receive custodial type care, your assets (other than your residence and various personal items which may be exempt under certain circumstances) are worth less than $2,000, and the income of the person entering the home (including Social Security) is no more than $1,737 per month for 2005, then you may be eligible for this government program, which can pay for substantially all of the cost of the nursing home. Moreover, it is possible for a married spouse who remains at home to preserve a significant portion of the assets of the couple if the other spouse is institutionalized. In 2003, the law permitted a minimum of $18,132 of such assets to be protected. And, depending upon the amount of such assets, a maximum of one-half (but not exceeding $90,660) may be preserved. In addition, in the case of married persons, it may be possible to have some of the income of the spouse in the nursing home paid to the at-home spouse, without affecting eligibility for Medicaid only.
Effective July 1, 1995, New Jersey instituted a Medically Needy Program for nursing home care. Persons who have income in excess of $1,737 per month for 2005, must be covered by the Medically Needy Program. Persons who have income of less than $1,737 per month have a choice between Medicaid Only and Medically Needy. Medically Needy does not have all of the coverage available through Medicaid Only. Medically Needy does not cover Medicare
Part B premiums, chiropractic visits, in-patient hospital services and out-of-nursing-home pharmaceuticals.
When considering an application for Medicaid, one should bear in mind that the rules are fairly complicated, and that transfers of assets to third parties (such as gifts to children) in order to become eligible for the program can result in a penalty period being imposed during which payments by the state will not be made for nursing home care.
OBRA-93 (Omnibus Budget Reconciliation Act of 1993), which is federal legislation effective October 1, 1993, made significant changes to Medicaid. Transfer of assets made within 36 months of application for Medicaid are penalized. The penalty is a period of ineligibility for Medicaid, determined by dividing the value of the assets transferred by the average cost of a nursing home in New Jersey. States must apportion the period of ineligibility between spouses so that only one penalty applies. In the case of joint assets, a withdrawal by one party is considered a transfer. The new law subjects transfers of income to a period of ineligibility. Transfer penalties can be avoided by returning all of the assets that were transferred. The law made significant changes in the area of trusts. However, certain types of trusts are still permitted. The secretary of health and human services was directed to promulgate regulations concerning annuities. As of this writing, those regulations have not yet been promulgated. States are now mandated to recover payments from the estates of Medicaid recipients.
If your application for Medicaid benefits is denied, if your Medicaid eligibility is terminated, or if Medicaid refuses to pay a claim, you have a right to a fair hearing before a New Jersey administrative law judge. At that hearing you have a right to be represented by counsel and to present evidence, including testimony, to support your case. The judge makes a recommendation to Medicaid regarding your case. Then, if Medicaid still denies your claim, you have a right to appeal to the Appellate Division of the Superior Court of New Jersey. In a situation where Medicaid has advised you that it intends to discontinue the payment of benefits, you may have a right to have benefits continued until your appeal has been decided.
At the time of this printing, the federal and state governments are considering substantial changes in both Medicare and Medicaid.
NURSING HOMES, ASSISTED LIVING & OTHER RESIDENTIAL FACILITIES
69. What are the rights of nursing home residents?
Nursing homes provide nursing, rehabilitative and health-related care and services that cannot be provided outside an institutional setting.
Residents of a nursing home have the same rights as they had when they lived in an apartment or their home.
They pay the nursing home monthly for room, board and medical services. The nursing home is, on the one hand, the landlord of the resident for room and board, and on the other hand, the employee of the resident for medical services.
Ordinarily, upon entry into the nursing home, the resident or a family member signs a contract setting out the terms of payment, price for each service, and so forth. The resident and the family also get a copy of the nursing home residents rights, which include such things as the right to privacy; to manage one's own finances; to unrestricted personal visitation; to present complaints without fear of reprisal; to equal access to quality care without regard to source of payment; to a written plan of care and services; and to free choice of one's physician.
If the resident does not haveenough money to pay for nursing home care, or runs out of money after paying privately, there are governmental programs that may pay for the care, including veterans if benefits, Medicaid and General Assistance. If a nursing home is Medicaid-certified, the facility cannot evict a resident because he or she becomes eligible for Medicaid. However, not all facilities accept Medicaid, and those that do not are permitted to discharge residents for failure to pay for their care. There are waiting lists for nursing home beds in many parts of the state, and those lists are longer for applicants who will enter as Medicaid or General Assistance eligibles than for those with substantial private resources.
The only way to be evicted from a nursing home is for non-payment, or if you are endangering yourself or others. Even then, there are notice requirements and the nursing home must find an appropriate facility to which you can go before the eviction can proceed. (A resident can always leave the facility for overnight visits or discharge him or herself).
If a resident needs to be hospitalized, the nursing home will hold the bed open for the resident's return as long as the bed is being paid for. Medicaid pays bedhold fees for 10 days. If the resident is in the hospital longer than 10 days, the resident gets the next available bed in the same nursing home upon discharge from the hospital. (Usually the hospital will keep the resident until the next bed opens).
If a nursing home resident has a complaint about the nursing home, he or she can complain to the administrator or to the New Jersey Office of the Ombudsman for the Institutionalized Elderly at 1-877-582-6995. The complaint to the ombudsman can be made anonymously or, if you give your name, it can be kept confidential if you so request. The ombudsman can go to the nursing home unannounced in order to investigate.
70. What are the rights of assisted living and other residential facility residents?
Assisted living means a coordinated array of supportive personal and health services, available 24 hours per day, which promote resident self-direction and participation in decisions that emphasize independence, individuality, privacy, dignity and homelike surroundings to residents who have been assessed to need these services, including residents who require formal long-term care. An assisted living residence is a facility that provides apartment-style housing and congregate dining while assuring that assisted living services are available when needed. Other residential facilities can include a variety of settings, such as personal care homes, adult day care, and adult medical day care services.
The rights to be expected at an assisted living or other type of facility are similar to those proscribed by law to nursing homes. Residences are to provide services that are consistent with the following principles of assisted living:
a) To provide personalized services and care to meet each resident's needs;
b) To foster the independence and individuality of each resident;
c) To treat each resident with respect, courtesy, consideration, and dignity;
d) To assure each resident the right to make choices with respect to services and lifestyle;
e) To assure each resident's right to privacy;
f) To nurture the spirit and uniqueness of each resident;
g) To encourage families and friends to participate in resident service planning and implementation; and
h) To provide opportunities for the assisted living facilities and programs to become a valuable community resource.
71. What are the rights of boarding home residents?
Every resident of a boarding home shall have the right:
a) to manage his or her own financial affairs;
b) to wear his or her own clothing and in the style he or she prefers;
c) to style his or her hair according to his or her preference;
d) to keep and use personal property in his or her room, except where the boarding house can show that this would be unsafe, impractical or interfere with the rights of others;
e) to receive and send unopened mail;
f) to unaccompanied use of a telephone at a reasonable hour and to a private phone at the resident's expense;
g) to privacy;
h) to hire his or her own personal doctor at his or her expense;
i) to privacy concerning his or her medical condition or treatment;
j) to unrestricted personal visitation with any person of his or her choice, at any reasonable hour;
k) to make contacts with the community and to achieve the highest level of independence and interaction with the community of which he or she is capable;
l) to present complaints on behalf of him or herself or others to government agencies or other persons without threat of reprisal in any form or manner whatsoever;
m) to a safe and decent living environment and care that recognizes the dignity and individuality of the resident;
n) to refuse to work for the boarding facility, except as contracted for by the resident and the operator;
o) to practice his or her religion or to abstain from religious practice; and
p) to not be deprived of any legal right solely by reason of residence in a boarding house.
72. Are owners allowed to retaliate against tenants who seek enforcement of their rights?
No owner, operator or employee shall serve an eviction notice upon a resident or take any other action in retaliation for:
a) the efforts of the resident or a person acting on his or her behalf to enforce any rights under a contract or any law; or
b) the good faith complaint of a resident or a person acting on his or her behalf to a government agency concerning the owner, operator or employee's alleged violation of any health or safety law, or other law regulating rooming houses or boarding houses.
73. Can I be evicted?
Residents of rooming and boarding facilities licensed by the New Jersey Department of Community Affairs may not ordinarily be evicted from such premises except for good cause as defined in New Jersey's Just Cause for Eviction Act. Unless otherwise directed or authorized by the Department of Community Affairs, an operator who wishes to evict a resident must follow the same procedures and substantive laws that govern the eviction of other tenants under the Just Cause for Eviction Act. Residents may not, therefore, be evicted unless an operator can prove one of 16 specific grounds for eviction. These grounds include: (1) non-payment of rent; (2) disorderly conduct; (3) destroying or damaging property; (4) violating a reasonable agreement in the lease or residency agreement; (5) violating the operator's rules and regulations; and (6) failure to pay a valid rent increase. The operator may only evict a resident by taking him or her to court and obtaining a court order called a judgment for possession.
Residents of residential health care facilities (RHCFs) licensed by the New Jersey Department of Health are not protected by the Just Cause for Eviction Act. However, such residents are entitled to at least 30 days advance written notice of a transfer or discharge from the facility. Additionally, except in an emergency, residents of RHCF's may only be removed from the premises (1) for medical reasons; (2) for their welfare or the welfare of other residents; (3) for non-payment of rent; or (4) for repeated violations of the facility's written rules and regulations. Residents may also be transferred or discharged if required by the department of health.
Elderly residents of nursing homes, residential healthcare facilities, boarding homes or any other such state-regulated facility offering health or health-related services to the institutionalized elderly, who experience abuse or exploitation from care providers, family members or strangers, should report these incidents to the Office of the Ombudsman for the Institutionalized Elderly at 1-877-582-6995.
74. How canI protect my rights?
The operator of a boarding house must make sure that a written notice of the rights of boarding home residents is given to every resident upon admittance to the boarding home and to each tenant already living there. The operator must also post the notice in a conspicuous public place in the boarding facility. The notice shall include the name, address and telephone numbers of the Office of the Ombudsman for the Institutionalized Elderly, county welfare agency and county office on aging.
Where their rights have been violated, residents can sue for damages, costs and attorney's fees. Any boarding or rooming house resident whose rights are violated has the right to bring a lawsuit against any person committing such a violation. The action may be brought to enforce such rights and to recover actual and punitive damages for their violation. A tenant who wins any such lawsuit is also entitled to recover reasonable attorney's fees and costs of the action.
GRANDPARENT'S RIGHTS
75. What is a summary of grandparent's rights in the state of New Jersey?
The relationship between a grandparent and a minor grandchild can be adversely affected under the following circumstances:
a. The death of the grandparent's child where custody of the grandchild is with the surviving parent (the daughter-in-law or son-in-law, as the case may be);
b. The divorce or separation of the parents of the grandchild;
c. The death of both parents of the grandchild; or
d. Neglect in care by the parents or parental unfitness.
In 1993, N.J.S.A. 9:2-7.1 was enacted. Under this law, a grandparent of a child residing in New Jersey may make application in superior court for an order of visitation.
The court will consider the following factors:
a. The relationship between the child and the grandparent;
b. The relationship between each of the child's parents, or the persons with whom the child is residing and the grandparent;
c. The time that has elapsed since the child last had contact with the grandparent;
d. The effect that such visitation will have on the relationship between the child and the child's parents or the person with whom the child is residing;
e. If the parents are divorced or separated, the timesharing arrangement that exists between the parents with regard to the child;
f. The good faith of the grandparent in filing the application;
g. Any history of physical, emotional or sexual abuse or neglect by the grandparent; and
h. Any other factor relative to the best interest of the child.
In June 2000, the U.S. Supreme Court restricted the ability of grandparents to gain visitation rights to a grandchild. The above New Jersey law is still valid. Nonetheless, the above law must be interpreted in conjunction with recent federal and state case law.
WILLS
76. What is a will?
A will is a document, executed in accordance with state law, which directs how some or all of your property is distributed at your death. An executor is designated under your will who assembles the assets of your estate and pays debts and taxes. If you have a child who is a minor, a guardian should be appointed under the will who would serve if you and your spouse die before the child reaches the age of majority.
77. When must a trustee be designated under my will?
A trust is a separate entity that may be established under your will when appropriate. If a trust arrangement is part of your will, a trustee is to be designated to manage and distribute the trust funds. The trustee is directed to distribute the funds held by the trust to or on behalf of the beneficiary of a trust.
78. Do all of my assets pass under my will?
Property in your name alone passes under your will. Such assets are known as probate property. Typical examples are bank accounts, stock certificates and personal property, such as jewelry and motor vehicles. Assets that are not governed by your will are known as non-probate property. Assets held jointly, IRA accounts, of non-probate property. Joint property passes to the survivor and IRA accounts, retirement benefits and life insurance are distributed in accordance with the beneficiary designation.
79. What is the role of non-probate assets in planning my estate?
The goal in estate planning is to coordinate the disposition of non-probate assets with the plan for probate assets. For example, if you desire a trust for your spouse under your will, consideration should be given to designating the trustee of this trust as beneficiary of your insurance policies. In this manner, a non-probate asset such as insurance will pass as part of the overall estate plan.
80. How is my estate distributed if I die without a will?
The disposition of your assets if you do not have a will is governed by state intestacy law, which may not be in accordance with your intent. Administration of an intestate estate generally requires additional time and expense. Non-probate assets such as joint property, IRA accounts, retirement benefits and life insurance are not governed by the intestacy laws.
81. Must my spouse receive any part of my estate?
In New Jersey, if one dies while married, a spouse generally cannot be disinherited. The surviving spouse is entitled to receive a share of your estate equal to approximately one-third of your probate assets with certain adjustments. With the advice of an attorney, you can limit the amount your spouse inherits and also restrict such inheritance to certain assets.
82. When should I consider a new will?
Separation or divorce are situations that give rise to consideration of a new will. Other such situations are death of one or more major beneficiaries, a change in your financial situation or a change in probate or death tax law. In addition, special will provisions are required in the event a beneficiary under your will is disabled, such as a physical disability or a mental illness.
83. Must an attorney be consulted to prepare my will?
The need for a will or the appropriate time to change a will involves legal questions that should be resolved after discussing the situation with your attorney. Moreover, the requirements for the validity of a will and the terms of your will are matters that require the advice of an attorney. While you can prepare your own will, this may be imprudent, as an improperly prepared will can give rise to many problems, such as invalidity of the will and court costs for your estate.
84. How can I make sure my wishes for my funeral are carried out?
Making arrangements ahead of time for your own funeral can assure you that your wishes will be carried out. These arrangements should be made with your family and local funeral director, and not put in your will. In most cases, wills are not read until the deceased has already been buried, so making plans with the funeral director and letting your family know which funeral home has your instructions is advisable.
In New Jersey, you can set up a burial fund to help pay
for your funeral. The arrangements are made with a funeral director, but this money is kept by the state of New Jersey in an interest-bearing account. This means that if you decide to change funeral directors, you can do so without any problems. You can also withdraw the money if you change your mind or need it for something else.
People preparing for Medicaid or SSI eligibility can also set up a funeral fund. The money deposited and the interest it accumulates will not be counted as an asset by either Medicaid or SSI. However, the fund for those on Medicaid or SSI is irrevocable, that is, once you go on Medicaid or SSI, you can change funeral homes, but you cannot withdraw the money from the fund. It can only be withdrawn at the time of your funeral.
LIVING WILLS
85. Do I have the right to refuse medical treatment?
Each individual has the right to refuse medical treatment if that individual has the information necessary to make that decision. This means that a medical provider cannot treat a person (except in an emergency) without the person's consent after that person has been told of the advantages and disadvantages of the proposed treatment.
86. What if I become incapacitated?
What happens, however, if a person does not have the capacity to make a decision or give informed consent to medical treatment because he or she is incompetent or comatose? With regard to the refusal of life-sustaining treatment, New Jersey law provides that if a person has expressed his or her wishes in an advance directive for medical care, those wishes will be respected by the doctor or other medical provider.
If you wish to make your medical preferences known now, when you are competent, so that your wishes will be known should you be unable to express them yourself, you should consider putting them in writing through an advance directive for healthcare. An advance directive may be either a living will or a durable power of attorney for medical care or a combination of both.
87. What is a living will?
A living will is a statement of the medical treatment you want or do not want if you should become incompetent and unable to communicate those preferences yourself. A durable power of attorney for medical care, also called a proxy directive, is a document in which you designate someone trustworthy to make those health decisions for you should you become unable to make them yourself. You should discuss your medical care preferences at length with any person or persons you choose as your proxy decision maker.
You may wish to have a document combining both your living will and proxy directive. In that document, you may state your medical preferences but provide that a proxy decision maker should be consulted if there is any confusion over your wishes or you have not considered a medical technology that was unavailable when your medical directive was written.
You must give your advance directive to your attending physician or the medical institution caring for you. Your advance directive will be used when your attending physician determines you lack the capacity to make a medical decision and a second doctor confirms that opinion.
If you have provided so in your advance directive, life sustaining treatment will be withdrawn only if you are permanently unconscious and your condition is terminal.
It may also be withdrawn if you have a serious irreversible illness. Your physician may also issue a do not resuscitate order based on your advance directive.
If you have an advance directive but change your mind, perhaps at a hospital, you may revoke your directive orally or by creating a new advance directive encompassing your most recent wishes.
Although the law does not require that advance directives be drawn and executed by attorneys, as does New Jersey law regarding wills, it is, nevertheless, prudent to consult an attorney for those important decisions so that there will be no question or doubt about your document when it is needed. Advance directives must be signed in the presence of two witnesses or in the presence of a notary.
For free copies of advance directive forms, contact the New Jersey Division on Aging, CN 807, Trenton, NJ 08625 or call the New Jersey Division of Senior Affairs Information, Referral and Assistance Service at 1-877-222-3737.
ELDER ABUSE
88. How is elder abuse a problem in the United States?
Approximately one million elderly Americans are victims of abuse, mostly women over the age of 75, often by their own caretakers. Elders who depend on relatives or neighbors find it hard to protect themselves against this abuse. Often, abused elders feel they should put up with the abuse because the abuser also provides necessary care. In 1993, the Legislature passed the Adult Protective Services Act, N.J.S.A. 52:27D-407. Below are a few terms covered in the act.
89. What constitutes elder abuse?
Under the act, abuse is defined as any willful infliction of physical pain, injury or mental anguish, unreasonable confinement, or the willful deprivation of services that are necessary to maintain a person's physical and mental health.
90. What constitutes elder neglect?
Neglect is defined as an act or failure to act that results in inadequate provision of care or services, which may result in serious injury or is life-threatening.
91. What constitutes the exploitation of a senior?
Exploitation means the act or process of illegally or improperly using a person or his or her resources for another person's profit or advantage. An example would be the misuse of a person's money or possessions.
92. Who is defined as a vulnerable adult?
A vulnerable adult is defined as a person 18 years of age or older who resides in a community setting and who, because of physical or mental illness, disability or deficiency, lacks sufficient understanding or capacity to make, communicate, or carry out decisions concerning his or her well-being, and is the subject of abuse, neglect or exploitation.
93. What are the legal reporting implications of reporting elder abuse?
A person who has reasonable cause to believe that a vulnerable adult is subject to abuse, neglect or exploitation may report the information to the county adult protective services provider or the local police. The person making such a report is immune from civil and criminal liability arising from the report. An employer or other person may not take discriminatory or retaliatory action against an individual who makes such a report.
94. Who makes the evaluation, determination and referral whether protective services are required?
The county adult protective services provider makes an evaluation and a determination regarding whether or not protective services are required. A referral is then made to the appropriate agency, hospital or organization.
95. How can a court order be obtained?
A court order can be obtained to provide such services. The county adult protective services provider is authorized to initiate guardianship, conservatorship or civil commitment actions if a permanent change in living situation is required. Criminal activity by a caretaker would be reported.
96. When will a criminal report be issued?
The county director of adult protective services is authorized to report criminal activity on the part of a caretaker to local law enforcement officials.
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