Long-Term Care, Medicare and Medical Assistance Interview Guide

1. Threshold questions

1. Threshold questions

Are you married?

Yes No

Are you or your spouse a veteran?

Yes No

If so, when, where, and with what unit did you serve?

Do you have children?

Yes No

2. Information on hospital stay

2. Information on hospital stay

What caused you to go to the hospital?

Were you in the hospital or nursing home before that? When?

How many days were you at the hospital?

Who was your doctor?

Were you an inpatient or outpatient or under "observation status"?

What kind of help did you need while you were there?

When were you transferred to the nursing home for rehabilitation?

Yes No

3. Medicare coverage

3. Medicare coverage

What kind of help did you need/get while at the nursing home?

Did the social worker talk to you about how to pay for your care?

Yes No

When did the nursing home say that Medicare will not pay for your care? How many days were you at the nursing home at that point?

What was the reason Medicare stopped paying?

Note that Medicare covers only 100 days in a skilled nursing facility.

Do you have supplemental health insurance?

Yes No

Do you plan on going back home?

Yes No

If so, what does your doctor say?

Do you have support at home?

Yes No

4. Determine what financial records to use when figuring out eligibility

4. Determine what financial records to use when figuring out eligibility

Have you had a Long Term Care Consultation?

A Long Term Care Consultation is a service of the county in which a public health nurse and social worker visit the client to determine eligibility for services and other programs.

Yes No

Have you ever been in a hospital or nursing home for 30 consecutive days? When?

Have you sent the county an Asset Assessment? When?

5. Determine whether the client is on private pay or is eligible for medical assistance

5. Determine whether the client is on private pay or is eligible for medical assistance

Do you have long term care insurance? What are the terms?

Are you married? Have you been married?

What do you own? With who (how titled)?

Do you own a house, a car, any burial space items, or personal property?

A house, one car, burial space items, and personal property are not counted for determining eligibility.

Do you own any assets that are jointly titled with someone other than your spouse?

Assets titled with someone other than the client’s spouse are not “available” to be counted for determining eligibility.

Yes No

Were any of those assets titled within the last five years?

The county will determine whether assets titled with another in the five years prior to application are gifts, or “uncompensated transfers.”

Yes No

Do you own any assets that cannot be sold or converted into cash?

Assets that cannot be sold or converted to cash are not “available” to be counted for determining eligibility.

Yes No

What other assets do you own?

Assets that are “available,” and either individually owned or jointly owned with a spouse are counted for determining eligibility.

Have you given anything away within the last five years?

Yes No

Have you created a trust? When?

6. Determine whether the couple can afford to have the community spouse live at home

6. Determine whether the couple can afford to have the community spouse live at home

Complete this section if the client is married.

If the ill spouse would like to live in the community, can the couple afford to pay the cost of care, monthly medical expenses, and the community spouse's expenses?

Yes No

If the ill spouse would like to live in the community, what county program will be used?

Consider Elderly Waiver, Alternative Care, and any other options available in the county.

If the ill spouse would like to live in the community, what will the monthly medical expenses be?

Is ill spouse considering living in a nursing home or in the community?

What are your monthly household expenses?

Make sure shelter expenses such as mortgage, heating, cooling, and telephone expenses are included.

What is your income?

What is your spouse’s income?

7. Spend down options

7. Spend down options

Complete this section if the client is over the assets threshold.

Who lives with you?

Make note of any protected persons, such as a spouse, child, disabled child, or sibling.

Have you spent, or could you spend, money on your home?

If client lives in his/her home, s/he can use money to repair or maintain home.  However, if the home is titled with a third party, client may only maintain home.

Yes No

Could you spend down your assets in another way?

Yes No

8. Spend down options – gifts

8. Spend down options – gifts

If ineligibility is caused by gifts and you are within five years of needing care, do you have enough assets or long term care insurance to cover the ineligibility period?

Yes No

Can you return any gifts that are contributing to your ineligibility?

Yes No

Are you considering a Veterans Home for your care?

If the client resides in a Veterans Home, s/he may be able to gift certain assets to his/her family without penalty.

Yes No

Are there people you could provide a gift to whose own eligibility for benefits would not be impacted?

Gifts to people other than a spouse are called “uncompensated transfers.”  The client should be aware that such gifts can impact the eligibility of the person receiving the gift.

Yes No

9. Spend down options - caretaker

9. Spend down options - caretaker

Do you have family that takes care of you?

Yes No

What do they do for you?

Do they live with you?

Yes No

How long have they taken care of you?

Do you have a personal services contract with them?

Yes No

Have you arranged for tax withholding for them?

Yes No

How did you come up with a figure to pay your family member?