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January 2019

On October 1, 2018, a new law became effective as it applies to certain advanced directives.  The change gives advanced practice registered nurses the authority to perform certain functions that could previously only be performed by physicians.

What Is an Advanced Practice Registered Nurse (APRN)?

Public Act 18-168 (“the Act”) defines an advanced practice registered nurse (a/k/a APRN) to mean an advanced practice registered nurse licensed under Connecticut law who is selected by or assigned to a patient and has the primary responsibility for the treatment and care of that patient.  

What Are the Changes to the Connecticut Law?

With respect to a living will (which is one type of advanced directive), the Act amends Section 19a-575 as follows:

"If the time comes when I am incapacitated to the point when I can no longer actively take part in decisions for my own life and am unable to direct my physician or advanced practice registered nurse as to my own medical care, I wish this statement to stand as a testament of my wishes.  I request that if my condition is deemed terminal or if it is determined that I will be permanently unconscious, I be allowed to die and not be kept alive through life support systems.  By terminal condition, I mean that I have an incurable or irreversible medical condition which, without the administration of life support systems, will – in the opinion of my attending physician or advanced practice registered nurse – result in death within a relatively short time."

The Act also amends Section 19a-577 of the Connecticut General Statutes with respect to an appointment of health care representative (which is another type of advanced directive). The Appointment of Health Care Representative form now reads as follows:

"I appoint [Name] to be my health care representative.  If my attending physician or advanced practice registered nurse determines that I am unable to understand and appreciate the nature and consequences of health care decisions and to reach and communicate an informed decision regarding treatment, my health care representative is authorized to (1) accept or refuse any treatment, service or procedure used to diagnose or treat my physical or mental condition and (2) make the decision to provide, withhold or withdraw life support systems."

What These Changes Mean for Terminally Ill Patients

So in the context of a living will, the APRN now has the power under the law to render an opinion about whether someone’s terminal condition will result in death within a relatively short period of time, if they don’t receive life support.  Similarly, in the context of an appointment of health care representative, the APRN now has the power under the law to make a determination as to whether someone understands and appreciates the nature and consequences of making health care decisions for themselves and whether they can also make an informed decision and communicate it to a doctor or an APRN.  Thus, the change in the law now gives the APRN – in addition to a doctor – the authority to do things that previously were reserved only for physicians.

Some folk might disagree with giving APRN’s the same kind of power as doctors but one thing is clear: it is now the law in the State of Connecticut.  If you have questions about how or whether Connecticut’s modified advanced directive statute applies to you, contact the estate planning attorneys at Cipparone & Zaccaro. We help to create clear and understandable estate plans for people by taking the time to explain the law and how it might apply to you.  

 

Many older Americans do not have the financial resources to pay for long term care in an assisted living or memory care facility. With the average cost of nursing home care in Connecticut costing about $156,000 per year, and in-home care averaging over $27,000 per year, you can see how a family’s financial resources can be quickly drained.

If you or a family member finds yourself in the difficult position where you need to figure out how you’re going to pay for long term care, Medicaid is often the inevitable answer. To qualify for Medicaid (also known as Title 19), you must meet both the asset and income eligibility rules. Each year brings a new set of important numbers for Medicaid in Connecticut.

What these Medicaid numbers enable you to do is to figure out:

  • How much money and assets the community spouse can keep while still allowing the institutionalized spouse to qualify for Medicaid
  • The dollar value of the counted assets the institutionalized spouse can have
  • The average cost of a nursing home used to calculate penalties for gifts during the Look Back Period
  • How much assets you can have to qualify for in-home care
  • Asset limits to qualify for Medicare savings programs which help pay for Medicare premiums

The chart below shows you the specific numbers you need to figure out how much assets you can have and still qualify for Medicaid. You can also find a printer friendly version of the CT Medicaid Numbers for 2019 here.

The new figures will only have meaning, however, if you understand how they work.  In a previous post on Medicaid eligibility numbers, we included a detailed example showing how the calculations are made.

UPDATED CONNECTICUT MEDICAID NUMBERS FOR 2019

January 1st of each year brings changes to several key Medicaid figures, which are adjusted for inflation. Below are the Connecticut Medicaid (also known as Title XIX and Husky) figures that apply as of January 1, 2019:

Lafayette executed a will in 1997 leaving his musical instruments and equipment to a friend.  He left the rest of his estate to his brother, James.  

In 2004, Jim established - in Connecticut Superior Court - that Lafayette was his father.  Lafayette had no knowledge that Jim was his son until it was established in court. Once paternity was established, the Court ordered Lafayette to pay child support for Jim because Jim had not yet reached 18.  

Then Lafayette died in 2007. One month after he died, Jim filed an application to administer his father’s estate with the Windsor Probate Court.  Jim did not know that his father executed a will in 1997, so he filed an application for an intestate estate.  One week later, Lafayette’s brother - James - filed the 1997 will and an application to administer his brother’s estate as a testate estate.  

Does Lafayette’s failure to provide for Jim in his 1997 will exclude Jim from his father’s estate?  That was the same issue presented to a Connecticut Probate Court in 2007 in the case of The Estate of Lynch.  

In the decision, the Court noted that there is a long-recognized preference against intestacy in Connecticut.  In other words, when someone executes a will, courts will attempt to honor the testator’s wishes and avoid revoking it or finding that it is invalid.  The Court also analyzed Connecticut General Statutes §§ 45a-257a and 45a-257b, which were amended a year before Lafayette executed his will.  Generally speaking, those statutes allowed certain classes of spouses and children to elect to receive a share of an estate, in situations where they have not otherwise been provided for in a will.  Further, the Connecticut Legislature made this change in order to allow children and spouses to inherit without requiring complete revocation of a will and thereby allow for the remaining unaffected provisions of the will to be admitted to probate.

Under C.G.S. § 45a-257b, a child born or adopted after the execution of a testator’s will receives a share of the estate.  In addition, C.G.S. § 45a-438(b) states that a father, adjudicated to be the father of a child, is considered to be the child’s parent for purposes of intestate succession.  In this case, the Court reasoned that a child for whom paternity is established under § 45a-438 – a so-called “after-discovered” child – is virtually indistinguishable from an after-born or after-adopted child permitted to benefit from the application of § 45a-257b.  Further, the Court stated that permitting a child for whom paternity is established after the execution of a will to share in an estate is consistent with the Connecticut Legislature’s intent and in keeping with notions of equity and fairness.  The Court also stated that children for whom paternity is established after the date of a will’s execution are within the class of children to whom this statute applies.  Thus, a child is entitled to an intestate share of an estate, so long as the date upon which paternity is established is subsequent to the date on which the testator executed his will and so long as the testator did not know of his paternity prior to his signing of the will.

In this case, there was no evidence that Lafayette intended to omit his son from his will.   Lafayette had not provided for Jim outside of the will, such as with a death benefit under a life insurance policy for example.  Based on these facts, the Probate Court found that Jim was entitled to share in his father’s estate under the laws of intestacy and that subject to this finding, the Court also admitted Lafayette’s will for probate.  The Court also found that since Lafayette had no other children, never married and did not provide for Jim’s mother in his will, Jim was found to be the sole heir of Lafayette’s estate.  

This case presents a very unique set of facts. Up until it was decided in 2007, this was a case of first impression.  If you are a child whose paternity was established by the Court or you are a loved one whose husband or father acknowledges that he is the parent of another person whatever his or her age, contact the probate attorneys at Cipparone & Zaccaro. We help guide people through a myriad of estate-related issues and provide people with advice on how to deal with situations like the one presented in this blog.