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Dale Drury Interview: “Asset Positioning & Protection Secrets: Save the Family Nest Egg and Save the House From Forfeiture to the State of California”, skilled nursing entitlements & veteran’s benefits.

“They just take our Ferrari onto a dirt track.”

Long-term skilled-nursing care is extremely expensive, and doubly so California. It will quickly wipe out a lifetime of savings, savings that, with professional guidance, a step-by-step walk through, would instead be left to the kids and grandkids.

Therese Johnson interviews Dale Drury about how much money Californian’s lose because they don’t know the Medi-Cal and Medicare rules on positioning assets, to protect those assets from forfeiture to the state and/or spend down at a nursing home. People get a little information from a professional consultant, and somehow then think that they can they figure out how to navigate the system on their own, and “They just take our Ferrari onto a dirt track and lose all their assets because they would not hire a professional who specializes in protecting your family’s wealth and inheritance from nursing home spend down and forfeiture to the state of California.”

Dale Drury | Axis Benefits Solutions | 916-439-0508 | AxisBenefitsSolutions.com

INTERVIEW TRANSCRIPT

Therese Johnson: Okay, so, I’m here with Dale Drury and Jessie Barrios with Axis Benefits Solutions in Sacramento, and today is November 20th, and we’re talking about the services that they offer for seniors. So, Dale, can you tell me what are some of seniors’ options for paying for skilled nursing care?

Dale Drury: Yes. We are called benefit care coordinators, and, what we do is we help seniors and veterans search any kind of program we can find for them to assist in paying for their long term care.
We start with explaining to people about the continuum of long term care, all the way from house-bound status down to a nursing home. And we use the centers for Medicare and Medicaid services. Medicare and new manual, which is put out every year by centers for Medicare and Medicare services, through Medicare and Social Security. And we explain to the people that themselves or their loved ones, who’ve qualified for Medicare health insurance because they’ve worked for forty quarters or ten years, and contributed to the Social Security coffer, so that not only pays them an income when they get to that age, but also it provides for a nursing home stay when they get to that point in the long term care continuum. So we go to page 118 and 119, and we go over their options for how their federal government tells us that we’re gonna be able to pay for a long term care need.

They start off with talking about long term care insurance. This type of private insurance can help pay for many types of long term care, including both skilled and non-skilled custodial care. This long term care insurance first came to be in their `80’s. For people that did get long term care insurance back in the `80’s, they’re finding out that they didn’t have an inflation factor build into it, that their daily benefit is 50 to 75 dollars a day, which doesn’t get them very far.

Some of them, it’s not an option for seniors because it has underwriting guidelines, health questions that they have to pass. If they do pass the health questions, the actuary is for the insurance company will look and say it’s very close time from when this person starts on this policy to when they gonna need to trigger it. So they usually charge them a very high premium, so it’s not affordable for the seniors. Some people that have it, this can help out with that daily benefit. I’ve seen some that are like a hundred and fifty dollars a day but certainly not 300 and 350 dollars a day. A lot of the long term care insurance companies are going, they’re getting out of the business too, so…

Therese Johnson: So, is that right?

Dale Drury: Yes, yes.

Therese Johnson: Well, I know, I have a client that I just met with and they’ve raised her premium, like you said, and now she can hardly afford it.

Dale Drury: Right.

Therese Johnson: And she’s paid into it for 10 years, so she’s asking me what do I do?

Dale Drury: The reason, what happens is, when long term care insurance first comes in a being, whatever the company is, they need to create a fund because one day people are going to trigger that benefit, right? So, what they do is they have open enrollment at first. This is what, this got Calpers in trouble, they had open enrolment for the first 10 years, no questions, no health questions. They need as many participants in that fund as possible to feed that coffer, right? Then what they need to do is: they need to turn around and invest that money wisely so it can grow, and that’s what happened with them, they invested in real estate and they lost a lot of money. So now they’re looking at all these people get to an age where they will need to trigger that benefit, and there’s not that reserve in there, so they need to do something. So one of the things they do is they raise peoples’ premiums and so a lot of the Calpers people have had their premium rate rise 87%. Or, what they do is they cut some of the benefits that they’re gonna provide. They do away with things like they did away with ambulating, for instance.

Therese Johnson: Yah, that was the case with this lady. She was first and they cut both. They raised the premium and cut the benefits so it’s like, really? (Laugh!)

Dale Drury: Yup!

Jessie Barrios: There’s more coming to Calpers. We’ve met with them this year; we know it this year and you’re still gonna have another increase, ‘coz actually they don’t have enough funds to actually pay out what they have.

Dale Drury: And a lot with their clients are gonna start coming to us. Because we’re gonna show them that actually they didn’t need to have the long term care insurance, it’s already built into the system, you know, and I’ll show you how.

Therese Johnson: First, that’s for skilled nursing care.

Dale Drury: Yes, skilled nursing.

Therese Johnson: But it’s not built in for assisted living or board and care?

Dale & Jason: No, no.

Therese Johnson: So they can’t still use it for assisted living and boarding care?

Dale Drury: That’s when we talk to them if they’re a veteran. We talk to them about the aid and attendance for that.

Therese Johnson: But I mean if they’re not a veteran?

Dale Drury: If they’re not a veteran and if they’re in assisted living or board and care stuff, what we do then is we talk to them about how we can come up with some kind of insurance product to make their money last as long as possible, like an annuity for life for instance. Or we’re able to work with the facility, to talk to them about coming up with some kind of payment plan, and that might take speaking their language, which Jessie is able to do, you know to connect. So they’ll want person to stay there, they’ll want them to be comfortable, and to stay there as long as possible, so sometimes it takes doing a little negotiating with them to work something out.

Therese Johnson: But the long term care insurance, if they bought one that covers not only skilled nursing but also assisted living, they are still good for this assisted living private pay, I understanding.

Dale Drury: Yes, yes. And it usually won’t cover all of it, so they have some out-of-pocket left over because I don’t think they fully anticipated how much the cost would rise, with the inflation factors, if they had one built in; it’s just not keeping up.

Therese Johnson: Okay.

Jessie Barrios: And then when the insurance looked at a lot of this stuff, they looked at, they got AIDS was gonna be the biggest money draw on their pocket, and so they were worried about that, but what they didn’t figure was all this Alzheimer’s dementia. Well AIDS was for a short period of time, then you passed away, physically passed away.

Dale Drury: Physically passed away.

Jessie Barrios: So you have all the people with dementia – they’re living a lot longer.

Therese Johnson: 8 years, average.

Dale Drury: Yeah.

Jessie Barrios: Average, we have some, that they forget, and they’re just living. They have no worries, no cares, no cleaning, no nothing, just get up, eat, watch TV, eat, watch TV, go to bed. Where’s their worries, where’s the care? So they’re lasting at least 8 years. That’s when they diagnose it and say “oh yes”, but now you have people lasting a lot longer. And in using the caregiver, that’s taking care of my home, is passing away 67% of the time. That’s just a stat, and that’s what their insurance companies didn’t forecast. That’s the problem – that is the real issue.

Therese Johnson: Exactly.

Dale Drury: So we go over the long term care insurance, if they have it, we look over the policy form showing how it works, how much daily benefit it has, how it’s triggered, and then we go over the next thing – personal resources. You can use your own resources to pay for long term care. Some insurance companies use your life Insurance policy to pay for long term care.

Ask your insurance agent how this works. So in this section, the first profession they mention is insurance agents, why? Well, because the federal government knows that there’s no other industry other than insurance that requires the kind of certifications and requires the kind of liability protection that this one does. We not only have to take all the necessary certifications, licensing and requirements and stuff, but we also have to carry errors and emissions insurance in case something is missed. We are on public display. Someone can go to the department of insurance, enter our insurance license number – boom, it shows issues, any kind of things that are against us, shows what insurance companies were contracted with.

So we have to, for responsibility as I’m sure you have talked about it before, if we start to sense this client is not fully able to make those decisions on their own accurately, we are responsible, our responsibility is to back away and say “okay, we need to bring another person in here, we need to find out who the durable power of attorney is, we need to have a loved one or someone present.” So we know that we are speaking to this person and they’re able to make those kinds of decisions on their own without help.

So, the insurance policies they’re speaking of, or single premium whole life and index universal life, both of these policies have a feature that you can borrow against, the cash value of it, to pay for your long term care. Then they talk about other private options. Besides long term care insurance and personal resources you can choose to pay for long term care through a trust or an annuity. We work with an elder law attorney, name’s Michael Anderson. And if we have a client that needs to have durable of power of attorney done, they need to have a conservatorship done, they need to have a trust done. We don’t do law – we send them to Michael Anderson. Have an appointment, then set-up appointment, and they go over and meet with him and he does a free hour consultation, that’s part of what we talked to the people, about the services provided, so that they can decide, you know, what it is they want to do, what are their goals, what it is they’re trying to accomplish. Or annuity, an annuity is through an insurance company, where’s there’s two kinds, there’s an immediate annuity, where they give them money and this share of monthly check every month with this amount, and they’ll send that to it until that money is exhausted, or they say “here’s the money, I just want to collect the interest. I’ll let you know when I want to annuitize it and trigger a monthly payment. That’s called a differed annuity. So they’re saying you can use those.

Then they talk about Medicaid. Medicaid is a joint federal and state program that pays for certain health services for people with limited income and resources. Ours is the only state that has a different name for it – Medi-Cal. There’s two types of Medi-Cal…

There’s a Medi-Cal that anyone of us in any age can get for health insurance, depending on if we are limited income and assets.

And then there’s long term care Medi-Cal, which the kind we’re speaking of, and what that does is it provides for the person’s stay in this skilled nursing facility. When someone gets on Medicare insurance, they have a part A and they have a part B. And the part A is their hospital stays, hospice, and long term care. It’s that long term care feature of the Part A that allows us to trigger the Medi-Cal benefit for people in the skilled nursing facility.

Then they talk about veterans’ benefits. This is the aid and attendance. This is where people veterans came back from war, this was established after World War II, they set this fund up, there’s now 22 billion dollars in it, and, if people, if the veteran was in the service for 90 continuous days of active duty, at least one of those days fell in these combat ranges, and they had an honorable or general discharge, they would qualify for aid and attendance for their spouse, for their widow and widower of the veteran who qualify for attendants when they get to the point, whether they either have dementia, or they need help with at least two ADLs, okay?

Therese Johnson: Okay.

Dale Drury: So, what we do is, we look at the guidelines and we just know that for the aid and attendance, if someone wants to trigger that benefit, if they have assets in this column, that’s fine, if they have assets in this column, that’s fine, but if they have assets in this column that are in excess of 80 thousand dollars, then that file is not in in compliance, so what we need to do is we need to help it become in compliance. So what we do is the excess assets, we maneuver from this column over into one of these two columns. We reposition the assets. This does a few things…

Therese Johnson: For protection?

Dale Drury: Yes.

Therese Johnson: Okay.

Dale Drury: It not only triggers the benefit, coz it now’s in compliance, it only saves them assets, protects the assets for the kids and the grandkids, and the system was set-up for a reason. Let me tell you in a second.

Therese Johnson: Okay.

Dale Drury: The third thing it does is it makes sure that the money coming in can now be paid to the care provider or to the facility where they at. So the bill continues to get pay. Other thing it does is it protects it from recovery, because when you trigger a benefit through the federal or the state government, a person passes away, they’re gonna try to recover, so it’s been put in a status that’s unrecoverable, so then it can be passed on to the kids and the grandkids.

The reason it was set-up this way is because when the government set this set they knew that we can’t just think about the generation now, we have to think about the next generation and the next generation and the next generation, and so on. If someone goes into a nursing home and the social worker says to him “You need to spend down all your assets, you need to spend all your money down till you’re under 2,000 dollars and then you can qualify for Medi-Cal” – that’s true. However, what’s happened to that money? It’s gone, right? If you can be protected and preserved, it can be passed on to the kids and the grandkids. That money can then put into, like, the insurance products they’re talking about for their long term care needs one day, so they can …

Therese Johnson: And this is what I think there’s the big problem. There’s a misconception and myth out there that it’s illegal to protect your assets, that you have to spend down, and that’s really not the case, correct?

Dale Drury: That’s not the case, correct. It was written that way for that very reason.

Therese Johnson: Exactly.

Jessie Barrios: Everybody at the nursing home, I’ve been the administrator, so we’re told from the companies, we’re told from Medi-Cal, “Get their assets under 2,000 dollars. Get their money down under 2,000 dollars, that’s – they’re reading their script. And, yes, that’s true, but that’s what they’re reading because they don’t wanna spend more or any a lot of time with you or telling you. Because they know if it’s under 2,000 dollars, all they have to do is rubber stamp it, and that’s why the misconception is. Coz if you do go to a Medi-Cal office, yes, they do tell you that, but I work with the Social Security office that worked the Medi-Cal office, and many workers that said “but you know there’s allowances.” Yes there is. Every year’s a new allowance. For 2013 it’s a hundred and fifteen thousand dollars, and you could have 2,898 dollars. But that’s why we tell you “get it under 2,000 dollars” on their…

Therese Johnson: Allowance for what?

Dale Drury: This is a married couple. One of them is in the nursing home, the other one can keep up to a $115,920 in cash assets for Medi-Cal. If they’re single it’s under $2,000.

Therese Johnson: And if it’s more than that then they need to do a protection asset plan.

Dale Drury: Yes.

Therese Johnson: Like with you guys…

Dale Drury: Yes.

Therese Johnson: Okay.

Dale Drury: They need to position those assets. So the worker, the case worker or the social worker at the facility, they sometimes tell them to get under 2,000 dollars a month, because they can’t do anything with the excess assets. They’re not a licensed insurance agent and can’t move it into Medicaid compliant product like we can.

Therese Johnson: And I think that’s with the problem lies. They don’t go far enough and tell people “you need to meet with someone that can protect your assets if you have more than this amount. Then you need to reposition your assets legally, so that you can in take advantage of these entitlement benefits that are available.”

Dale Drury: That’s right, that’s right.

Therese Johnson: So, I think we need to do more educating of nursing homes.

Jessie Barrios: Nursing homes, assisted living, we’ve been going to independent apartments, so we’ve been going out there, and, as I said, we’ve been teaching and teaching and teaching. And some have started to come but some came got the information, they only listen to, like you said, part of it without getting all the education, and went out and try to do it themselves, and then they came back and said “this wasn’t right”, we said let’s sit down, let’s walk through, “Oh, I didn’t do that”. I said “Well, this is like a little minefield your walking through.”

Dale Drury: They just talk our Ferrari onto a dirt track.

Jessie Barrios: Yeah and just went out there, I know.

Dale Drury: Yeah.

Therese Johnson: So I think you’ve done a good job in explaining what the entitlement benefits are and where they come from. Okay so…

Dale Drury: When you got the state’s book.

Therese Johnson: So there’s more, okay.

Dale Drury: Yup. There is the California Department of Aging. So here we got the federal, right?

Therese Johnson: Okay.

Dale Drury: Then the federal says “okay, now you states have your own, right?” So the state sends this one out, we look at page 17, “Paying for long term care”. They’ve got their own section in here. They talk a little bit about what Medicare covers first, and then they get into “Can now use my life insurance to pay for long term care?”, so they talk about life insurance.

Therese Johnson: And you can.

Dale Drury: Yup, here they talk about the annuities, here they talk about the trust, here they mention home equity conversion – reverse mortgage.

Therese Johnson: So these are all other options of paying for long term care.

Dale Drury: Yeah.

Therese Johnson: But they all, these all deal with pretty much dipping into your assets?

Dale Drury: These were similar. This one, just like in the federal book – the life insurance, the annuities, the trust. But here they mention the reverse mortgage coz in the state of California you can use your reverse mortgage to pay for your long term care.

Therese Johnson: But wouldn’t that be kind of a last resort?

Dale Drury: Well, it depends on what a person’s needs are. Because, say, for instance, that the person owns a home, right? They’re at home, and they wanna trigger the benefit. They can do the reverse mortgage and they can, coz remember what’s gonna happen after they die – the government’s gonna try to recover, right? So they can do the reverse mortgage and you have a couple options. You can have monthly payments, and we don’t advise them to do that, because if they’re having a monthly payment come out and they go to the nursing home, that payment becomes share of cost.

Therese Johnson: Okay.

Dale Drury: Or they can do a lump sum, so we them do a lump sum, pull it all out, and move it in the one of the compliant products.

Therese Johnson: Like an annuity.

Dale Drury: Yeah, or the single premium whole life.

Therese Johnson: Which will give them income?

Dale Drury: The annuity would when they trigger it. When they annuitize it. But if it just sitting there, it just a differed annuity, it’s not being annuitized, then it be can’t become share of cost. If they get to the point where they want to annuitize it, yeah, we can do that, but there’s gonna be that risk if the person goes in the nursing home, then it’s gonna become share of cost. So everybody’s case is different. We have to look at everybody’s particular situation. But what it does is it helps them trigger the benefit and it avoids recovery, so we wanna make sure people understand fully what they’re options are with that. And then they talk about Medi-Cal. Now they’re using it by name coz this is the state’s book, and here they’re talking about the aid and attendance, so, very similar in what the two have as options.

So when we go through that with them, then we show them that, no matter where they are in the continuum, I’m here. We have access to people to help. We have companies that can do in-home care providing, we have companies that can help with coming into the home and helping with the home care, ADL assistance, and if they have a, we have placement companies that we work with…

Therese Johnson: Like us Senior Care of Sacramento (laugh…)

Dale Drury: Yes, like you, and that’s what we would do, is we say, okay, we can, let’s say you refer someone to us you, and it’s always good to have a sit down right away with the person, because then we can find out what the situation is, what the goals are, and we can come up with the plan, keeping you and the loop at all times on what’s going on right? And then they say “Okay, well this is the plan, this is what we wanna do, we want to have them at home.” “Okay.” So, we find out, do you provide home care? Do you have company that provides home care with what you guys do?

Therese Johnson: We refer to in-home services as well, we refer, we also are referral service like you in that regard, we refer to people like you who can help them with getting their aid and attendance, and to in-home care if they need in-home care, and also to help them if they’re looking for assisted living or board and care, we narrow that search down for them and customize it, saving them a lot of time, energy, and money.

Dale Drury: So, what I would do is, I would do the intake form, find out what they wanna do, and they’d say “we wanna have them at home”, and I say what you need to do is get back to Theresa and she will help you find a home care provider to do that, right? So I’m becoming a trusted advisor for them and now I’m saying “go back to Theresa for this” right? Or they have him at home and then all of a sudden dad has a fall, goes into the hospital, doctor says “Can’t go back home. You need to get in touch with Theresa and she’ll help you find a facility” that would be best for, so what we do is we return the person, the client, back to you. Then we get all the way down here. Do you refer to nursing homes?

Therese Johnson: Ah, not generally, no.

Dale Drury: Okay, so…

Jessie Barrios: There’s no referral fee or anything because they’re afraid of a Medicare, anti-kickback loss. So that’s why we look at the client and we ask you “how are they doing” coz we’ve had some clients come in, and the family’s like “Oh, she’s up all night, she’s wandering, she needs to be locked.” So there’s only two locked buildings here in Sacramento, so I can tell ‘em, “you may wanna go look”, and they look like you’re committing a crime. “Okay, that’s those”, I said, what else are you looking for?” I said, “But if you want keep her safe, those are only two I know in Sacramento. If you want to rehab’” I said, “where do you live close by?” That’s my biggest question, is where do you live, “Why?”, “Coz they need to be close to you if you’re gonna go visit.” Coz if they’re gonna be, “Nobody wants her in that area”, that’s what I explain to them, so I send out the referral. Nobody wants her in the area, so go as 10 miles, 20, 30, 40. “How come a lot of approval for her to go in Stockton?, “That’s because nobody in the area wanted her.”

And that’s where, knowing a lot of the admission people, I can make her call. ”Hey, can you do me a favor? They tell me they want to stay close by, “You’re able to admit her? Here’s the insurance.” So we’re trying to take, that’s where a lot of times a lot of you have insurance agents, you get a referral and they’re trying to take the client. I told her “We don’t do that. If you want to sit with us, we have no problem in doing that. If you already know the plan; the plan is to be in assisted living.” “Okay, so how much is assisted living going to cost, and which one is it?” So, in that way “Here’s the cost”, then we get all the information Dale’s taken, we put it on the board, we make it, “Okay, how much will they need to move from here to here to pay for the rest of their lives.” And they didn’t have to worry about it. “Here it is”, and then we’ll give them the options, and we still don’t force them to do it.

Dale Drury: In this office…

Therese Johnson: Right, we do that also, we create a long term care plan, and a lot of times people are misinformed and they’re told that they have to go to a nursing home, but then, when I go out and doing the assessment, they actually qualified to be in an assisted living as well. And, especially in situation like you’re talking about like they say “Oh, they have dementia, they’re a wanderer, they may need a locked facility”, but that doesn’t mean it has to be skilled nursing. There’s plenty of assisted living’s that are safety and locked facilities that have memory units, that they can also go there, and so… But it always gets down to the budget. It always about that almighty dollars, so, unfortunately, that’s where they really need an adviser like you guys to come in and help them, because we’re not financial advisers, we specialize in helping them get the care needs and creating a long term care plan and getting them the resources.

And people like you help them get their ducks in a row. And you know finalize the details of the plan. We gave them the outline of what the plan needs to be, and who can help them with each part of the plan, and, of course, we help them with the care plan – getting the actual care in place, so that’s why I’m writing my book “Saving Senior’s Savings”. Because there’s so many people that are coming to me, but by the time they’re coming to me, they need this help, and they haven’t got their ducks in a row yet. So, I’m trying to prevent that and educate people, “Okay, you need to be start preparing in getting all these, you know, your finances ordered, so, that by the time you’re calling me, you have some funds or you know what it’s gonna cost, and you’ve made a plan so that you can afford it.” Coz so many people just are in a crisis situation, and then it’s so much harder on the family and the loved ones and everyone involved, that it just creates so much stress and chaos.

Jessie Barrios: I can tell you when I worked at the nursing home, like Florin, and I advised families, I got in trouble because, “What am I doing?” “I’m showing them how to save their money and not paying me privately”, so I’m helping the families.

Therese Johnson: This was for skilled nursing.

Jessie Barrios: Skilled nursing. So I would go, let’s say Kaiser, “You have Kaiser insurance. You’re seniors; you got Kaiser, Kaiser Advantage?

Dale Drury: Senior Advantage.

Jessie Barrios: Senior Advantage. And you’re like, “Oh, you gotta sign up first.” So you sign you up as you’ve become older. They came to me and the person couldn’t swallow. So I talk to the family member and they say “Kaiser only gave me 10 days.” I said, “Your husband needs about 30 to 45 days to be able to really swallow. As I talk to the speech therapist, she was my director, and the other speech therapist, they figured about 32 days that were needed. So we try to get that and Kaiser denied it, so then we showed her how to, I showed her how to appeal coz I know that go to the 10-day appeal process. Show them how to appeal 10 more days, show them how to appeal, I got a call from Kaiser, “What the heck are you doing?” “What are you talking about?” “Why are you showing them how to appeal our process?” “Because that’s the way it goes.”

Therese Johnson: That’s what they needed.

Dale Drury: That’s what they need.

Jessie Barrios: And I did that a lot, and so I got a call, then I told them finally, I told the family just un-enroll from Kaiser, becomes straight Medicare / Medi-Cal, and you’ll get all the therapy you need. “Really? What about deductibles?”, “If you’re Medi-Cal they’ll pay those.” So I showed them the whole process.

Dale Drury: See, all your HMO’s have a board. Everything has to go to this board for approval, whether it’s a procedure, being paid for something or whatever. Where if we get on Medicare Medi-Cal, “medi-medi” it’s called, then its paid coz they have zero share of cost, right? Or, it might be a situation where they wanna be admitted, they need to be admitted in nursing home, we had this happen. And what happened was their HMO kept saying “No, we’re not gonna pay for it”, so we took them off the HMO and then Medicare will pay for it.

Therese Johnson: Exactly.

Dale Drury: Yah.

Therese Johnson: And do you know how this, is this gonna change with the Obamacare plan, do you know?

Dale Drury: No.

Jessie Barrios: No.

Dale Drury: And that won’t change.

Therese Johnson: Okay.

Jessie Barrios: The process will be the same because if you dis-enroll anytime in the month, at the end of the month you’re dis-enrolled for the next month. And that’s where we, he was still in a nursing home, he had Kaiser, we dis-enrolled them – at the end of the month it became Medicare. We billed Medicare correctly and we took care of his needs. And then, when that happen 3 or 4 times, I gotta call from Kaiser, “Why are you disallowing our clients?”, “Coz you’re not providing the services they need, you know, and they called the cooperate office and complained, “Your administrator cowboy out there, dis-enrolling people, helping them, what’s wrong with him?” Then they find out that I helped them with their Medi-Cal, showed them, guided them. We even worked with the other non-profits in the area.

Therese Johnson: The hospital needs to be paid for the services if the person needs them. So, they didn’t get upset with you at that point, did they, the hospital?

Jessie Barrios: Not if they get the point, but they want them, for HMO’s, they want them, the more money they get from Medicare. If you’re an HMO, you have Medicare, you’re an HMO, that means that the insurance company gets the money. If I’m only gonna pay the nursing home 300 dollars a day, but Medicare’s paying 600 dollars a day for me, so who’s making the funds in between. The HMO and that’s how that works, okay so there’s a lot more for a…

Therese Johnson: So you gets in the politics of the whole insurance industry and, and that’s what gets in the way, and that’s what’s created this myths…

Dale Drury: The money thing.

Jessie Barrios: Yes.

Therese Johnson: Yah, the money thing, that’s what’s creating the misperception and the mess about “It’s illegal.” It’s not really illegal; it’s just the insurance companies wanting to get their share the pie when maybe that’s not the best interest of the client.

Dale Drury: Yah, it needs to be, that’s the number 1 thing – what is the best for the client. And then, also, as you do in your business, we have to understand the family dynamics too – what’s going on with the family? Because we want that time, when the person is in this continuum, to be a blessing for the family, and have the most comfort and quality of life for the person, right? And, too often, if money gets involved, people start getting like this, right? So what we wanna make sure is “Hey, it’s already been set up. What we’re gonna do is we make sure, we show you what’s available, we make sure it’s compliant, we have all this stuff set so all of you gotta do now is go visit mom and dad whenever you want to.” And, as we’ve talked about, once you get the money situation settled, then some of them don’t show up anymore to go visit. And they’re the ones that sat turn and go “Oh, it’s not about the money, it’s about the care”. But as soon as the money is all set, taken care of, they’re gone. So you have them put a bowl candy in their room so people come visit them. (Laugh)

Jessie Barrios: (Laugh) Yah.

Jessie Barrios: Once your family loved one is visited, I tell you put a bowl candy, hard rock candy, they will visit your mom or dad or anybody else – all the employees… Those are the simple things, I notice, I saw, observing, they go “How can I them to mom, I want them to see mama”, “So put a bowl candy”, I say, “Go to dollar store, buy a bag, dump it in, next day it’ll be gone.

Therese Johnson: (Laugh) Well if it were really that easy that would be nice but, so…

Dale Drury: It works.

Jessie Barrios: It works.

Therese Johnson: Alright, well I got a couple more questions here. So, a lot of people think if they have a living trust that they are protected, is that true?

Dale Drury: That would be a Michael Anderson question, the attorney.

Therese Johnson: Okay.

Dale Drury: …that we always send, we always refer to him.

Jessie Barrios: Because there has to be certain language in that trust. What he’s taught us – certain language has to be in the trust. He looks for it. It has to be set up accordingly, so he actually goes through it again. So he sits down, that’s why he says, “Okay I’m gonna look at it, this is the language,” coz he actuals are CANHR as well, CANHR.

Therese Johnson: Okay.

Jessie Barrios: So he works with CANHR…

Therese Johnson: Which is California Association of Nursing Home Reform.

Jessie Barrios: So he works with them. He works for a living, he’s part of their group, so that’s why he looks at the language, makes sure it’s right, and, if it’s not, then he’ll tell you, he’ll redo it. It’s not an astronomical cost. He’ll tell you that this is not done correctly.

Therese Johnson: Okay.

Jessie Barrios: So that’s a legal question that he will answer and go through your paperwork.

Dale Drury: So he’s an elder law attorney who is also first in Medicaid planning, VA and Medicaid planning, so he knows all the regulations and the compliance rules…

Therese Johnson: So he can help with the protection asset plan.

Dale Drury: Yes.

Therese Johnson: And having it all put in place correctly.

Dale Drury: That’s what we do with him.

Therese Johnson: Okay.

Dale Drury: We say “Here’s the goal,” and he sets it up. He does that free consultation to learn what needs to be done, and then he takes care of it.

Therese Johnson: Okay, so if a senior says “I have Medicare, that means I’m covered, right?” Is that correct?

Dale Drury: Covered for a period of time. But in a nursing home, yeah, they’ll go in the nursing home and they’ll cover them for up to…

Therese Johnson: But it a short term, unless they set up a plan with someone like you, and apply for the long term section, so that’s really another misconception. If they have Medicare, it does not mean that their long term care is covered.

Dale Drury: Up to a hundred and twenty days.

Therese Johnson: Up to 120 days.

Dale Drury: They’ll do a 20, that they’ll look after like 18 days, right?

Jessie Barrios: Yeah, I’ll explain to you. For the nursing home or for any HMO, 0 to 20 days is covered at a hundred percent. No matter, if you haven’t been in a hospital within the last 60 days.

Dale Drury: For 3 days, right?

Jessie Barrios: For the last 60 days, you haven’t been in the hospital, you go to the hospital, you have to stay three midnights. That’s where the people get confused, it’s three midnights. If you got to the hospital at 9 o’clock at night, and they didn’t meet you till 1 o’clock, that midnight that did not count. Your head has to be on the pillow, at midnight, in the room in order for it to count, and that’s where people get confused. And that’s why people say “Medicare’s gonna cover for me,” and they go to the nursing home, and all of a sudden it’s private, because you didn’t have three midnights in the hospital, at night, checked in.

Therese Johnson: I’ve had that issue with clients.

Jessie Barrios: Yes, that’s the start of it. Now let’s say you had that qualifying stay, and that’s why teach we teach families – you need to tell me your qualifying stay, so you let the families know to use the rules qualifying stay. So we use that verbiage “qualifying stay”. So now they got 3 mid nights, now they go to nursing home – 0 to 20 is covered that a hundred percent, no deductibles, day 21 through 100 is deductible. If you’re straight Medicare, it’s 152 dollars per day deductible. If you’re straight Medicare. If you’re on an HMO, it’s whatever your HMO designated as your deductible.

Therese Johnson: So it’s not covered for 120 days, there’s a deductible of a 125 dollars a day.

Jessie Barrios: At $150 at least.

Therese Johnson: After the 21st day.

Dale Drury: Yes.

Jessie Barrios: After the 21st day for Medicare. Now, for the HMO, might be little bit less, but it’s not a 120 days, its 20 days, and then the remaining 21 through a hundred, that’s covered and you have to have – if you’re doing physical therapy – you haVE to be progressing every day in order to be covered, once you hit a plateau.

Therese Johnson: And, so, now I’m confused. You’re saying it’s covered, but there’s a deductible every day, so either it’s covered or it’s not, I’m confused.

Jessie Barrios: It’s partly covered.

Dale Drury: It’s partly covered.

Therese Johnson: It’s partly covered.

Dale Drury: It’s partly covered.

Therese Johnson: But they’re still having to pay the $125 a day.

Jessie Barrios: $150.

Dale Drury: $150.

Therese Johnson: Or $150 a day. Unless you have an HMO, that might lower that little bit.

Dale Drury: Yes.

Jessie Barrios: Yes.

Dale Drury: Or you have Medi-Cal that I’ll cover that.

Therese Johnson: Okay.

Dale Drury: Okay, if you have Medi-Cal.

Therese Johnson: Or Medi-Cal will cover usually the remainder.

Dale Drury: The deductible, yes.

Therese Johnson: Okay, if you qualify.

Dale Drury: Yes.

Therese Johnson: If you’ve set-up your protection asset planning, you apply for Medi-Cal and you did that ahead of time.

Jessie Barrios: Correct.

Therese Johnson: It doesn’t just automatically kick-in, you have to do this planning in advance.

Jessie Barrios: Exactly.

Dale Drury: And we actually, when we sit down with the family, we explain all this little things, “This is how this works, this how this is done,” so that they have questions, they have concerns, whatever, they can call us and we can walk them through it, over and over and over if we need to.

Jessie Barrios: Yeah.

Therese Johnson: So I’ve heard the state will lien your home for reimbursement, is that correct?

Jessie Barrios: Technically, yes.

Therese Johnson: To pay for skilled nursing care.

Jessie Barrios: Yes.

Therese Johnson: If you haven’t done work with someone like you to set up the protection.

Jessie Barrios: Correct.

Dale Drury: That’s right. Let’s just say you did it on your own, and this is why the family’s came back, you did it on your own, and you put mom on Medi-Cal, and she was on Medi-Cal for, I’m gonna say 4 years, coz the house is worth $200,000. So Medi-Cal figures spent $50,000 a year on mom, in the nursing home, for four years, how much is that?

Jessie Barrios: 200 grand.

Dale Drury: 200 grand, how much is the house worth?

Jessie Barrios: 200 grand.

Dale Drury: 200 grand, “Here’s the lien,” and that’s what we tell them, “You went from step A to Z without walking all the way through. There was no meeting, there was nothing information, you didn’t give the right information to them, you’ve tried to hide money, trying to, they’re coming.” So that is technically is correct. But if you do it correctly – that’s why we do Medi-Cal compliance, we have everything lined up A to Z. So we’ve never had anybody, that we’ve walk all the way through, come back and have an issue or problem.

Therese Johnson: Okay. So now, when you do this protection asset plan, I understand there’s a look back period. Can you tell me a little bit about the look back period and how that works?

Dale Drury: 30 months right now. And it something is not done in compliance, then it can disqualify that person for being on the Medi-Cal benefit until they get past that time period of the 30 months. So if something was done improperly, a year ago, then they’ll be disqualified for that year until, after that point.

Therese Johnson: So if somebody comes to you ahead of time and they put a protect asset protection plan in place, is there still a 30-month look back period?

Dale Drury: No, no.

Therese Johnson: So you are able to circumvent the 30-month look back period by following the rules and regulations for each asset, by putting it in a protection plan?

Dale Drury: That’s correct. So we’re able to circumvent that 30-month look back.

Jessie Barrios: Coz if it’s on compliance, they just look at it.

Therese Johnson: Coz I have a lot of clients, they’re thinking, “Oh, there’s no point in being in the protection asset, because there’s this like 3-year look back period anyhow, so, by the time I do that, mom or dad’s not gonna need the care,” or, you know, maybe “They’re on their last legs,” or whatever, “So what’s the point?”, but that’s really not accurate thinking.

Dale Drury: That’s not true.

Therese Johnson: That’s not true. They can avoid the 3-year look back period by doing this planning and putting these measures in place, correct?

Dale Drury: Correct.

Jessie Barrios: Correct.

Dale Drury: That’s correct.

Therese Johnson: Okay, so I’d like, I know you guys – you’re main specialty is the aid and attendance benefit, so, can you talk a little bit about that, about the veteran’s aid and attendance, what the process is, for that, maybe some time lines and time frames in that procedure.

Dale Drury: Yeah, that’s one of the, the aid and attendance, is one of the things We do as much Medi-Cal as we do the aid and attendance, but they both operate under the same principle, and that is, they both have asset limitations, and, so, if the assets are in excess, they need to be positioned, right? The aid and attendance benefit is: once somebody is under $80,000 in cash assets, once we know that they had the 90-day continuous active duty, we typically ask to see their DD-214, their separation papers if they were veteran from the Korean War on to today.

Therese Johnson: You say 90-day continuous active duty. I thought they only had to be in the military during war time for 1 day to be eligible.

Dale Drury: No. Ninety continuous days of active duty, and at least one of those days had to fall within these date ranges right here.

Therese Johnson: Okay.

Dale Drury: And an honorable or a general discharge, and then, once we get the file in compliance, with the assets, and once we get the doctor’s, there’s a form called the 21-2680, which is the house-bound or a facility’s doctor’s, like a prescription you would write. He fills that out, we get a copy of the separation papers, the DD-214 or if they’re World War II, it’s just called a separation, yeah, it’s just a separation document, it doesn’t have a form number. But then we’re able to give the packet to the person to fill out, pertinent information, what the person’s income is, expenses are. We then take that package, put it together, we scan it, email it and send it to the veteran service officer in Woodland, named Billy Waxter, you know Billy, who them looks it over, makes sure it’s good, and he sends it on through to the VA. We’re getting them triggered, some around 4 to 5 months. Now, for the veteran, it takes us about 6 to 9 months for the spouse, and Billy tickled because it’s all in compliance by the time he gets it from us.

Jessie Barrios: Sometimes he even gets a case he refers, “You know, that’s not gonna fly,” then he can call John or Dale say “Hey, can you help this family get in compliance”, and we have them come over.

Therese Johnson: And the benefit is retroactive, correct?

Dale Drury: That’s correct. Benefit is retroactive down back to the date of the application. So from the time Billy gets it, looks it over, he sends it in, boom, when he sends it in, the clock starts ticking, so it’s retroactive to that point.

Therese Johnson: And then, another thing that I think that a lot of people aren’t aware of – if they apply for this benefit and it’s retroactive, and they don’t have the money right now, if it’s a spouse it’s gonna take nine months for it to be processed. And then in 9 months, they’ll get that retroactive money, but in the meantime, if they need to be placed in an assisted living or board and care, or they need some in-home, care I understand there’s an insurance company that will help fund that money…

Dale Drury: Yeah, you…

Therese Johnson: …to pay for them. Yah…

Dale Drury: …I’m not familiar with that company.

Therese Johnson: But they are limited to certain assisted living’s, and the assisted living’s contract with them in order for them to pay the monthly benefit amount that they are expecting from the VA benefit, and then they do charge a 10% interest on it, but they do pay for that to assist people when they need this service right away and can’t wait for that 9 months or need…

Dale Drury: Yeah.

Therese Johnson: …which is another benefit that’s nice, that’s out there for people. So, alright, well you’ve given us a lot of information and I think you’ve covered all the entitlement benefits, right? Pretty thoroughly, where they come from, what they cover, and how people can get them. I think that, one of the biggest problems I have with my clients is, they ask me “So, can I do this myself?”, and, I think, from what you’ve all said, and the myriad of each asset that has to be protected, under compliance with different rules and regulations, creates a bureaucratic hodgepodge that is very difficult for anyone to do on their own, and like you said, you guys even use an attorney to deal with some of these compliance issues, and to have the correct documents in place. And having the power of attorney forms and all that. So, my advice to clients is, “No, I don’t recommend that you do it yourself, and would you agree with that?

Dale Drury: Yes. I mean, if I’m sick, I can treat it myself, you know, I can go to the drugstore and get things. But, if I’m sick and I wanna get better, and not to mess around, I go see a doctor, right? Well, in essence, what we do is we understand how all the forms need to be filled out, we understand how to put the file in compliance, we’ve got a brain trust here of different people from nursing home backgrounds to insurance backgrounds to customer service backgrounds. So, we can able to work with that family and come up with a program and a plan, and that’s most important. Everybody’s afraid of the unknown,’What’s gonna happen, what are we gonna do if mom’s money runs out?,” you know, “What’s gonna happen and how long?,” you know…

Jessie Barrios: I can answer that question – it’s coming home, that’s what I tell them, “Mom money runs out, what are we gonna do?” Mom’s coming home, unless you’re putting mom in a nursing home, and she already has Medi-Cal in place. Oh, I said so either you protect the money to help take care mom or to pass on to the families. Do you want to stretch it out as far as you want?

Dale Drury: Or stretch it out as long as possible.

Jessie Barrios: I ask the tough questions for them. I tell them “You want soft questions you can ask Dale, Dale’s very sweet.” I say “You want reality, what happens, when I was in nursing home and some one ran out of money, and they didn’t qualify for Medi-Cal, and the family’s money was taken. I wrote a 30-day letter of discharge, had the ombudsman in, had the family in, had their attorney in, they were still going home because they weren’t paying. And that’s the reality of it right now. They can’t throw you out, but they can issue to proper paper work to get you home coz, as long as there’s a family or somewhere to go, you may be going.”

Dale Drury: Coz he gets a call every week, “How’s your account receivables. And if they’re not good, he’s in trouble. It’s a job, right? They like seeing us come in because we’re able to get this financial stuff handled. We’re able to trigger the benefit, we are able to work with the family, so that eliminates a lot of the hassle for them, and they, when that phone call comes, you go “Yah, we got it handled, we got this company that’s working on it, boom boom boom, here’s the plan.”

Jessie Barrios: And we go to the nursing home, we talk to them. I call them up and I say, “I suggest, here’s where we at.” Because, when you’re financial responsible, you’re power of attorney for your mom, and, you’re like, “Well I just want to write the check to the nursing home.” I’m like, “As long as you’re okay, Medi-Cal going to your checking account, go ahead and do that.” They’re like, “What?” I show them how transferring the liability from yourself to the nursing home, to all these a little things, a lot of little things that people don’t cover and understand. We show them and tell them they’re like, “I didn’t know that.” The ambulance bill, the your pharmacy bill. You’re still gonna have deductibles. “So how do I stop them coming in and depleting mom’s money?” So we’ve even show them that as well.

Therese Johnson: Exactly, well that’s wonderful. Now, I’d like you to tell me a little about, let people know that you are a veteran Dale.

Dale Drury: Yes.

Therese Johnson: Tell me, tell me about that.

Dale Drury: I was in the Air Force, I was a Morale, Welfare, and Recreation Officer at Panama City, Florida. I would, there was five functions under MWR – there was the aero club, and the saddle club, and the officers club, and the non-commission officers club, and pre-kindergarten and so…

Therese Johnson: What’s an MWR?

Dale Drury: Morale Welfare and Recreation.

Therese Johnson: Oh, okay.

Dale Drury: So I would go to each one of these functions once a week and write an article for the base paper. Tough tour of duty, Panama City, Florida. And then they had a, this is in ’80, and then they had a reduction in force going on so…

Therese Johnson: So you’re very familiar with what veterans go through with the bureaucracy and the paper work and all that whole situation. Coz you’re a veteran yourself.

Dale Drury: Yeah, and the federal government is great at a coming up with programs. They’re great at funding programs, but they’re not so good at marketing the programs. And not so good at explaining how to actually access the programs. So, that’s when my business partner, John Webb and I, we’ve been working with seniors and veterans who were just doing Medicare health insurance, and when we saw this, this is a huge need. That’s 22 billion dollars. Even Billy Waxter tells us, even in his own county of Yolo County, only 5% are being accessed right now. Coz people either don’t know about it or they don’t know how to trigger, right? And these are the people that deserve it. They spent time, went through a lot protecting us and serving our country, and now in the time when they need the help, so we’re able to provide that, that’s really good.

Therese Johnson: Alright, well thank you, I appreciate that. And that’s why I’m here, coz we really need to educate people about these benefits that are out there and services that you guys are providing here at Axis Benefit Solutions. So I wanna thank you for meeting with me today and have an interview, and if people would, if our listeners and readers would like to get a hold of your services, can you give us your contact information here.

Dale Drury: Yes. My name is Dale Drury. My telephone number is 916-439-0508. Or, my email address is daledrury50@yahoo.com

Therese Johnson: Okay, and, this is Theresa Johnson with Senior Care of Sacramento. So, please, if you’re out there and you need asset protection, you need any of these services we’re talking about, or you just have questions, you wanna clarify your situation, if you recognize your situation and this sounds like exactly the kind of help you need from Dale or Jessie at Access Benefit Solutions please call Dale, and again his number is 916-439-0508. Thank you.

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