Practice area
Elder law and long-term care planning
Most families meet these questions in the middle of an emergency. Answering them in advance is cheaper, calmer, and produces a better result for everyone involved.
Levy Law & Mediation Firm, P.C. helps clients plan for the long-term management of their assets, both during their lifetime and after their death. Plans are built around the goals and objectives of each family rather than assembled from a template, because the right structure depends entirely on who is involved and what they are trying to protect. Suzanne Levy's stated aim in this work is to help people get the services they need while preserving their dignity and their savings.
When families come to us about this
You are in your sixties or seventies and healthy
This is the ideal moment. Every option is available, nothing is being decided under pressure, and the planning can be done thoughtfully over a few conversations.
You are the adult child who can see what is coming
A parent is starting to struggle and you do not know what documents exist, what they own, or who is supposed to be making decisions. Getting that picture clear is the first step.
You want to stay in your own home
Aging in place is the most common goal we hear and it is achievable, but it takes planning around care costs and how it will be paid for.
A rehabilitation stay is being cut short
Medicare coverage for a skilled nursing facility stay has been denied or terminated on the basis that the patient has plateaued. That determination can be appealed.
How the process works
The work starts with the questions that actually determine the shape of a plan. These come up in nearly every engagement:
- Who should hold the power of attorney?Which child, or which combination of people, should be authorised to act on the client's assets, and what happens if they disagree with one another.
- Is Medicaid planning necessary at all?Whether Community or Chronic Medicaid planning is likely to be relevant, and if so on what timeline. Not every family needs it.
- Revocable or irrevocable?Whether a revocable trust or an irrevocable trust is the right instrument. This is a real trade-off between retaining control and achieving protection, and it deserves a proper discussion.
- How should children inherit?Whether assets should be held in trust for children for their lifetime, for a limited period, or given outright. Where a child may be heading for a divorce, planning can protect the inheritance from becoming part of that dispute.
- What are the tax consequences?Which assets should be liquidated or transferred, and in what order, to limit capital gains and income tax exposure. Assets are analysed individually rather than moved wholesale.
- What is the timing?At what age an irrevocable trust for Medicaid purposes should be created, what should be transferred into it, and how spend-down options can be maximised if they become necessary.
Medicare and skilled nursing facility appeals
Adults aged 65 and over with Original Medicare can receive rehabilitation services in a skilled nursing facility where it is medically necessary, subject to a coverage limit. Families frequently engage the firm when that coverage is cut short.
- At some point during the stay, the beneficiary's services are reviewed by a Quality Improvement Organization.
- The facility submits medical records supporting an end to coverage, and a Notice of Non-coverage is issued to the beneficiary.
- That notice sets out the reason and the right to appeal. The reason given is very often that the beneficiary has plateaued.
- Once the Notice of Non-coverage is issued, an immediate appeal can be taken to challenge the determination.
- The first level of appeal is decided by the review organization, and benefits may be reinstated at that stage.
- Coverage is then typically reviewed again within a short period, so a first-round success does not always end the matter.
- Coverage amounts and coinsurance figures change annually. We will confirm the current numbers for your situation rather than relying on published estimates.
Where we handle these matters
The firm advises elder law clients from Great Neck and from the Woolworth Building at 233 Broadway in Manhattan, serving families across Nassau, New York, Queens, Kings, Westchester and Suffolk Counties.
Elder Law & Long-Term Care: common questions
More questions are answered on the firm's FAQ page.
When should we start elder law planning?
Earlier than most people do. Planning while everyone still has capacity and there is no immediate care crisis keeps every option open and costs less than intervening later. The practical answer is that if you are asking the question, it is a reasonable time to have the conversation.
What is the difference between a revocable and an irrevocable trust?
A revocable trust can be changed or undone by the person who created it, which preserves control but offers limited asset protection. An irrevocable trust gives up a degree of control, and in exchange can protect assets in ways a revocable trust cannot. Which one is appropriate depends on what you are trying to achieve, and it is one of the central decisions in any plan.
Can planning protect my child's inheritance if they get divorced?
It can be structured with that risk in mind. Whether assets are left outright or held in trust materially affects how exposed an inheritance is to a child's divorce, and it is one of the questions we raise directly, because families often have not considered it.
Will transferring assets create a tax problem?
It can, and that is why transfers should not be made informally. Moving or liquidating an asset can trigger capital gains and income tax consequences that families do not anticipate. Part of this work is analysing which assets should be transferred, and in what order, to limit that exposure.
Medicare says my father has plateaued and is stopping his rehab coverage. Is that final?
No. A Notice of Non-coverage carries a right of appeal, and an immediate appeal can be taken once it is issued. Plateaued is the standard rationale given in these notices, and it is frequently challenged. The deadlines are tight, so the notice should be acted on straight away.
Ready to put a long-term care plan in place while there is still time?
Most families come to us with a decision that already feels overdue. A first conversation is about understanding where you actually stand and what your options are.