Check Up: Book answers questions about nursing home coverage

Gene Sauers of Levittown.
Gene Sauers of Levittown. (COURTNEY MARABELLA / Staff)
Posted: March 16, 2014

Gene Sauers began working at the Pennsylvania Department of Public Welfare on Feb. 17, 1964. The Beatles had appeared on The Ed Sullivan Show the week before. Medicare for the elderly and Medicaid for the indigent would be signed into law a year later.

"There were tremendous political fights. It was worse then," Sauers said. And the rollout? "The problems now with Obamacare are nothing compared with the problems with Medicare. It took two decades to get it resolved."

By that time, Sauers was managing DPW's Bucks County Assistance Office, gathering the half-century of experience that he writes about in a slim paperback with largish print, Medicaid, PA Nursing Homes, and You.

The contents are about as sexy as the title, and just as basic - 82 pages of frequently asked questions divided into chapters with headings like "Application Procedures: Where Do I Go? Who Can Apply?" and "Transfer of Assets During the Look-Back Period: What's OK, What's Not, and Why Not?"

With one of three people who live to 65 or older spending some time in a nursing home, and long-term nursing home care costing $9,000 to $12,000 a month, according to Sauers, these are common questions.

Residents of other states will get little out of the book, as Medicaid - the entitlement program associated with the long-term poor that in fact pays for a substantial portion of nursing-home care - is largely run out of Harrisburg. But Pennsylvanians - particularly members of the middle class faced for the first time with DPW mysteries like phones that are never answered and office lines that go on for hours - may appreciate the level of detail.

Sauers, 81, ran a consultation and services firm for the elderly in Bristol Township after retiring in 1991, finally cutting back to semiretirement at his Levittown home office two years ago.

He can talk your ear off about countable assets, and is keen to correct people's fear-inducing misconceptions about qualifying for medical assistance.

"Most of the time what they hear is incorrect: that they are going to lose their house, the government is going to take it," he said by phone.

"People are told, 'You've got to cash in your life insurance.' Well, that's not true."

As he explains on page 15, for example, a policy's cash value, minus a $1,000 exemption, does count as a resource when calculating eligibility. But cashing in an $18,000 death benefit for its $12,000 cash value would kill the policy. A better choice would be to take an $11,000 "loan" on the policy (the cash value minus the exemption) and buy an irrevocable burial reserve. Upon death, the insurer will deduct the loan from the full death benefit and pay the beneficiary $7,000; it cannot be taken by the state.

The book is filled with similarly detailed tidbits (which would be a lot easier to find if it included an index). All are about eligibility and finance; this book will not help you choose a nursing home.

Sauers fondly remembers the days when, he said, DPW workers had to be extra certain they were correct when rejecting applicants. Now, he said, the aim seems to be the opposite: to demand so much unnecessary paperwork "they make it a condition of eligibility."

Still, he says he has no interest in helping people cheat - just in supplying them with information for a fight.

The self-published book sells for $21.12 (plus shipping) at Amazon.com.


dsapatkin@phillynews.com

215-854-2617

@DonSapatkin

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