Senior Care Live: May 2, 2026

Listen in as host Steve Kuker, President of Senior Care Consulting, visits with David Wiley, President & CEO of Kansas City Hospice.  David addresses mainstream media stories on fraud in hospice and the impact it’s having on the industry as a whole, and while some bad actors are exploiting regulatory gaps, Kansas City Hospice works hard every day to preserve access to high-quality community based hospice care.  KC Hospice has local governance, serves local people, and exceeds 8 out of 8 national benchmarks on client outcome measures for a rolling 12 months. Clearly, what’s happening is not a failure of the hospice model of care, it’s the result of a subset of providers exploiting the healthcare system.  Then, David announces the Circle of Lights memorial event taking place on Tuesday May 19th at 8pm at Mill Creek Park on the Plaza.  For more information, visit www.KCHospice.org/COL. Then, Steve explains Medicaid, what it is, what it pays for, and how to qualify as well as the “division of assets” for married couples.  Tune in to learn about how the difference in State Medicaid rules could save the community spouse hundreds of thousands of dollars!  #SeniorCare #SeniorCareLive #SeniorCareConsulting #SeniorLiving #KansasCitySeniorCare #SeniorCarePlacement #SeniorCareAdvisor #Franchise #SeniorCareFranchise #SandwichGeneration #Hospice #PalliativeCare  

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Transcript

Speaker 2 0:01

Are you caring for an aging loved one? Are you a senior searching for answers? Welcome to Senior Care Live, a program dedicated to you providing information, education, and resources for seniors and their caregivers. And now, America's Senior Care Consultant, Steve Kuker.

Speaker 0:23

Hello, and welcome to Senior Care Live. I'm Steve Kuker, your Senior Care Consultant, and I really appreciate you tuning in today. We have, this is an important subject. We have an excellent program today with my friend and special guest in studio, Mr. David Wiley. He's the president and CEO of Kansas City Hospice and Palliative Care. And David, welcome back to Senior Care Live. It's good to be here, Steve. All right. I am so glad that that we are. I hate that we have to talk about this, but I'm so glad that we are. And as always, we'll just j,p right into that topic today. I've seen a lot of news stories, too many, frankly. And, you know, while I don't work in hospice specifically, I do work in the space of senior care in a lot of areas of that. I've just seen a lot of the mainstream media news stories talking about fraud and abuse in hospice. It, that hurts me. and there are so many hospices just being shut down, particularly on the West Coast. That seems to be kind of a hot spot for this terrible activity. So I would just love to hear your perspective on the topic and how this impacts the industry overall.

Speaker 3 1:35

You know, Steve, you're right. It's been a big news story recently, and frankly, I'm glad. you know, the recent coverage has taken , a political tone, but this really isn't a partisan issue. You know, this is about doing the right thing for patients and families, it's about how we run our business. this is about a program's integrity and accountability and ensuring patients and families receive the care that they deserve. Aaron Powell And you mentioned politics.

Speaker 2:04

I hate it that everything seems to be politicized. This had nothing to do with politics. Trevor Burrus, Jr. No, right.

Speaker 3 2:08

This is this is a right or wrong, black and white situation.

Speaker 2:11

Yeah, that's right.

Speaker 3 2:11

That's right. And and you know, I w the actions that that are being taken care or taken by the administration right now, , as well as by by the Center for Medicaid and Medicare Services, CMS, , you know, it reflects the increased attention to concerns actually raised over a long period of time regarding some fraudulent activity , in parts of the hospice system. And these efforts are really aimed at addressing a group of bad actors. These are providers that are exploiting regulatory gaps while the rest of us are working to preserve access to high-quality community-based , care. And frankly, it's just a huge white-collar crime.

Speaker 2:57

Yeah, it's just , awful. , and you know, I've been working with you and Kansas City Hospice for a really long time. Now, I know you take quality very seriously. So how does news like this make you and your team react?

Speaker 3 3:12

Well, first, you're right. , Kansas City Hospice, you know, quality care is our number one priority. It's what's described in those reports is not, you know, who we are. , and it's really it's not how we operate. It's not something that we would ever tolerate. You know, some of the key facts , for listeners to know is that first of all, Kansas City Hospice is a nonprofit. We're Medicare certified, and we've been proudly taking care of Kansas City , families for a very long time. , we've built our reputation on integrity and clinical excellence, and frankly, an unwavering commitment to patients and families who trust us. They they trust us in their most vulnerable moments. , that trust is sacred and , we protect it fiercely. And I'm not just talking about me. I mean, it's very important to me, but it's a whole lot , of people ,, you know, more than me that that care about this. Our leadership team, we're 100% local, and we're all experts in our fields, in our professions, in our work. Each person brings dedication and passion to the role at Kansas City Hospice. And, you know, we're in it for our patients and our families. And I just, you know, our clinical teams, I just , they too, their leaders, define what it means to bring expertise, compassion, and comfort together to provide the absolute best care to our patients and families. So I think it's important to note that we follow a very strong compliance plan. It's reviewed and monitored regularly by , one of our board, , our board of directors committees. All of our controls and compliant activities are reported there. , and speaking of our board, , the commitment to Kansas City also includes an all-local governing KCH board of directors who provide oversight. We're all about Kansas City people looking out for one another. All right. And local people, local governance, and that that's your point, right? Absolutely. And you know, when we hear these stories in news, , it's an important reminder of why we're so meticulous about documentation, our record keeping, and our compliance. ,, we don't do this just because we focus on making sure that every note, every record, every data point tells the true story of the care that we provide. And it protects first and foremost our patients, our organization, and our team members also. , when we do things right, the medical record shows it, and that matters now more than ever.

Speaker 5:49

Absolutely. And you know, I just I hate stories like this. I mean, I love that it's coming to the surface and it's being addressed. , and like like you said, it's a black and white issue. It has nothing to do with anything other than it is what it is, it needs to be stopped for sure. , but it gives it tends to give an entire industry a black eye. Absolutely. Or make people question, well, I don't know. I mean, is this legitimate? Is this fraudulent? And it just causes it just casts a shadow, and I just hate that. So , , what are some of the accusations or charges? I mean, what exactly are we looking at with all of all of these stories that we're hearing about?

Speaker 3 6:24

Well, Steve, it's being reported that some of these hospice companies enrolled Medicare beneficiaries in hospice care without their knowledge or failed to provide services. Investigations have also uncovered alleged schemes involving illegal kickbacks and what's called license flipping, in which hospices sell newly acquired licenses before regulators can intervene. Several individuals connected to those operations have been sentenced to prison and ordered to pay millions of dollars in fines, but many, many remain at large and in operation. , it's being reported that one of the clearest indicators across fraudulent hospice agencies is often few to no deaths under hospice care.

Speaker 7:07

I heard about that in a in a report specifically that like 99 percent of the patients actually graduated from hospice and ended up not really needing it. And that that's not the norm.

Speaker 3 7:18

Obviously. So you know, sophisticated bad actors they can manipulate, you know, some surface indicators more easily than they can manipulate the basic reality that hospice serves people at the end of life, which is what we just talked about. I mean, that makes beneficiary-level analysis, death attribution, and site visits more important, and that's really what's underway now.

Speaker 7:41

And like you said, all of your documentation, you're meticulous about these things, so that there is no question at all because it's all right there.

Speaker 3 7:49

100 percent. And you know, there's various triggers and things that can be red flags. So we proactively monitor those red flags. In fact, if it is looking like it's something's happening, we audit every single chart to make sure that if the documentation doesn't support the level of care, then we actually don't bill it.

Speaker 8:08

Yeah. Okay. No, see, and that that's fantastic. And I imagine you have safeguards in process. Like you just said, you audit every single chart. And , you know, one of your team members sees something or has a question, they're going to raise their hand and we're going to look into that.

Speaker 3 8:22

You know, I think it's really important. ,, you know, if one of our team members has a concern about a patient situation, a family interaction, a process that doesn't feel right, or anything else that gives them pause, they bring it to their manager and they know it's expected that they can't sit on it, they can't assume somebody else is going to say something. They really do have to speak up. And like I said, this isn't just encouraged, it's absolutely expected across our organization. And we have a compliance phone number that they can reach our compliance officer at any point. , I also think it's important to be clear what's happening is not a failure of the hospice model of care. Yeah. You know, it's the result of a subset of providers exploiting the healthcare system, and it and like you said, it absolutely has to stop. You know, this issue is deeply frustrating to my colleagues and I and the other high-quality mission-driven hospice providers, you know, especially nonprofit organizations. We serve Kansas City with compassion and integrity for decades. So, you know, we just can't allow that actions of a small number of companies erode public trust or discourage families from seeking hospice care when they need it. That would be the absolute worst case scenario.

Speaker 9:36

If you're listening to this you're wondering about, you know, well, wait a minute. I hear about all this, but I know that Kansas City Hospice and probably many others. Like you said, this isn't a hospice situation. No. This is the actions of a of a few bad actors giving everyone a bad name. Just reach out to Kansas City Hospice if you have a question. They would be glad to answer that for you. Talk about whether you or your loved one qualify for the services. , let me just give you the phone number here. It's 816-363-2600. That's 816-363-2600. Or you could also visit the website. Excellent information there at kchospice.org. And David and I will continue this important discussion coming right up. But first, the Senior Care Live question of the week. Hospice companies are overseen by the CDC, the Centers for Disease Control and Prevention, which is a division of HHS Health and Human Services. Is that statement true or false? What do you think?

Speaker 2 10:43

You're listening to Senior Care Live on the Senior Care Broadcasting Network. For more information, visit SeniorCareLive.com. We'll have more with Steve coming up next.

Speaker 12:04

Welcome back. You're listening to Senior Care Live on the Senior Care Broadcasting Network. For more information, visit SeniorCareLive.com. All right, back to the Senior Care Live question of the week. Hospice companies are overseen by the Centers for Disease Control and Prevention, a division of health and human services. Is that statement true or false? And the answer is false. The answer is false.

Speaker 3 12:35

And David, why is that statement false? The Centers for Medicare and Medicaid Services, or commonly known as CMS, a federal agency within the U.S. Department of Health and Human Services, is the primary agency that oversees hospice providers. CMS sets the conditions of participation, regulates Medicare and Medicaid compliance, and works with state health departments to inspect and certify hospice agencies.

Speaker 13:01

Excellent, Thanks for clearing that one up. And , David, before the break, you had mentioned that , Kansas City Hospice belongs to a special organization.

Speaker 3 13:10

You know, we do. , it's an organization, a national organization that's , made up of other like-minded nonprofit hospices. It's called the National Partnership for Healthcare and Hospice Innovation, or NPHI. And they're working closely with federal leaders to advance targeted, evidence-based solutions to close loopholes, strengthen enforcement, and protect the integrity of the hospice benefits so that all patients and their families receive the high quality care that they deserve. And we absolutely support , this approach. ,, and here's one of their recent statements that really resonates with me. It's quote, at its core, hospice care is about trust, trust from patients and families during some of the most vulnerable moments of their lives. That's why NPHI is committed to supporting decisive action to address bad actors while continuing to uphold and protect the high standards that define this field. And I really couldn't agree more.

Speaker 14:12

Yeah, I love that statement. And that's , that's just bottom line.

Speaker 3 14:15

That's excellent. Is there anything else that you'd like to add? You know, I just wanted to mention that they're so involved. In fact, this week , they attended the House Ways and Means full committee hearing titled Protecting Patients and Taxpayers Cracking Down on Medicare Fraud, which , I think that just demonstrates their commitment to what's happening. In terms of you know, kind of other thoughts, Steve, two things. I guess how we are monitored and how seriously that we take quality care , I think is important to mention. We're measured, as I just kind of talked about in that answer, and surveyed by the state of Missouri and the state of Kansas on a regular cycle. And for us that means three surveys because we have a separate provider number for both Missouri and Kansas, and we also provide home health services to our pediatric patients, and , that's one provider number for both states. So three provider numbers, three separate audits or surveys. , and you know, we're really fortunate in Missouri to have an experienced survey team of clinicians. That means they know the regulations, they dig deep, and I always frame it up for our team when they walk in the door unannounced, and it happens, you know, regularly. Yep. It's our time to shine. So , that happened in January and February. We had both of our Missouri surveys, and I really couldn't be more proud of the outcome because our teams perform so well and they perform well under pressure. ,, it's validating to be able to share , that success.

Speaker 15:49

You know, I love that. It's our time to shine. You know what? Most people most other leaders of these organizations, they're like, oh my gosh, you go whoop, whoop, they sound the alarms, and you know, the state's coming in the building, and they have code words and everything. Your approach is it's our time to shine. This just demonstrates , , a tangible difference in management and that that goes throughout the entire organization. I'm so glad you shared that. That's awesome. So how else do you monitor how you're doing?

Speaker 3 16:24

You know, we also are rated by our families, the families of our patients that we have the privilege to care for, and that's a really big measure of how we kind of grade ourselves. And here's how we shake out. We consistently beat national benchmarks on quality measures. In fact, we're above the national benchmark on eight out of eight client outcome measures on a rolling 12-month basis. So, for example, families , you know, likely to recommend, would you recommend this care 91% of the time versus a national benchmark of 87. Overall rating of care, same thing, 91% versus a national benchmark of 87. , and our families rank Kansas City hospice higher than the national benchmark on communications, timely help, treating the patient with respect, emotional and spiritual support, family training, and symptom management. So and this isn't just me saying it. I mean, I love to brag about what we do, but these are literally family satisfaction survey results that are collected and reported by Medicare, and it's through the consumer assessment of health care providers and systems. And , it's the most recent data that we have, and it it's on a rolling 12-month basis.

Speaker 17:43

See, and so if there's any question again, I love the quote earlier. This isn't about hospice, this is about a few bad actors. So , if you want to work with the best, in my opinion, it's hands down, it's no contest, reach out to Kansas City Hospice and Palliative Care, 816-363-2600, or online at KCHospice.org. And David, it's May, and just want to ask you one more thing. ,, I assume you're hosting Circle of Lights this month. Oh my gosh. Yep, we absolutely are.

Speaker 3 18:20

I'm so glad you asked. ,, it's such a great event. It's one of my favorite events of the year. And for any listener who doesn't know, ,, it's a community-wide event, and we hold it at Mill Creek Park, which is the big, beautiful park with the big fountain on the plaza on the east side. ,, it's a really beautiful, peaceful gathering. This year it's taking place on Tuesday, May 19th. It offers a chance to honor loved ones in a meaningful way, surrounded by the warmth of our community, and you can light a luminary in memory of your loved one. It's super easy to reserve , that actual luminary online , on our website, which is kchospice.org/ COL. And , people just need to do it by May 14th so that we can have it ready. And even if you're not going to be able to attend, you absolutely can , light have a luminary lit. We have volunteers. Last year I think we had nearly a thousand luminaries, so it's a really cool , it's a cool experience. And , so we're thankful for those who choose to offer gifts in tribute of their loved ones, although that's not required. And just know that any gifts that we do receive go straight forward to the provision of care and support to our families that are coping with serious illness, end of life, and grief throughout the Kansas City community.

Speaker 19:44

Yeah, right here in our community, any donation or any gifts provided , go with KC Hospice serving those individuals in our community. That's one of the one of the things I just love about this. And so I'm so happy the circle of lights is a go. And , and I hope to see you at the park on , Tuesday, May the 19th. , that website one more time.

Speaker 3 20:05

You can go to kchospice.org forward slash C O L. If you wanted to check out our quality , information, it's kchospice.org forward slash best in care.

Speaker 20:16

All right, and I'm going to have my name on a couple of luminaries. I always like to , provide a gift when I do that, one for my dad and then one for my , grandparents. So , I'll have a couple of them down there and , , I look forward to joining you ,. And what a beautiful event, what a perfect place to do. It's just a it's a the whole the whole thing is just so well done. Thank you. Appreciate it. So all right, we'll have more coming right up.

Speaker 22:06

Welcome back. You're listening to Senior Care Live on the Senior Care Broadcasting Network. For podcasts of the program, visit SeniorCareLive.com or wherever you get your podcasts. So again, I want to thank , David Wiley for coming onto the show and just tackling a just a really important, timely, and frankly a disturbing topic of all of this fraud that's going on. And look, and again, I just I keep coming back to it's not hospice. It you have a few bad actors out there, as there are act bad actors everywhere, in every business and all over the place. I don't get it. I'm my DNA, I'm just not wired that way. So I'm glad that this is being addressed. I'm glad people are getting caught. Red-handed with all of this fraudulent activities and , one hospice agency, I think they had like 95, 99% of their of their patients , actually graduated and did not need hospice anymore, didn't meet the criteria because they improved and got better. Well, , that number isn't even remotely close to the national average. So, oh that there's a red flag right there. So I I'm glad this is being addressed. But it kind of blows my mind that all of this fraud could occur. Just a quick story, and this has been quite a while back before I started senior care consulting, but I was working with my friend, he owned a Medicare certified home health agency where we would send out , nursing for skilled intermittent nursing visits, physical therapy, occupational therapy, speech therapy to help people in their home. Usually, you know, per discipline, you know, maybe one to three times a week for eight-week periods. Okay, and if you if you were improving and needed more help, then we could extend that to another eight-week period until you were better or hit your goals or plateaued. And so I'm just sitting here thinking, how in the world are all these people getting away with all of this fraud? It kind it just blows my mind because I went through the audits and the surveys, and these are surprise surveys. They walk into your door, the state, and I'm glad this is done. This is very, very good oversight to keep everyone on their toes. And they walk in the door unannounced, surveyors from the state, in this case, you know, Kansas or Missouri, all states do this, and they say, Hi, we're the state , surveying , agency, and we're here to audit your business. And so what you do is basically you help them and answer their questions and provide files and all of this documentation, and you need to just basically do what they ask you to do and provide everything because they're checking everything out. They come in, they tear the place apart, and they want to make sure that you're following your own written policies and procedures and following state and federal guidelines. And if you're not, they write a citation, they call it a deficiency, and then it is ranked or graded, so low level, mid-level, high level. And so obviously, lower level better, fewer deficiencies better. And so , this happens , in the hospice, ,, in the hospice part of the healthcare system as well. You have unannounced , audits where people come in the door, and like I said, and I look, I've been around this stuff a long time. Most people just dread it. David says, this is our time to shine. Let's shine. ,, that's I just can't even tell you what a wonderful, what an incredible , outlook on this is. And they know that they're going to do well because they do well. They monitor everything, they audit every single chart, t hey document absolutely everything, and they are meticulous about this stuff. I'm just telling you, we are so fortunate to have Kansas City Hospice serving , clients and patients and families in in our community. It is unbelievable. And again, they are the polar opposite. Couldn't be further from all of these negative stories that you hear about , in the news today. And again, I'm so glad , that David wanted to address this and tackle this tough subject. , and again, David, you know, thank you for doing that. , that was that was excellent and very timely. I really appreciate that. All right, so let's , shift gears a little bit and just wanted to talk about Medicaid. I've had a lot of questions here lately about Medicaid and what it is and what it pays for and how to qualify for it and all of that fun stuff. So let's jump in. So I'm going to talk about Medicaid today , relative to Medicaid paying for long-term care. So every single time I work with a client , with through with senior care consulting, we have a talk about you know the financial side of things. How are we going to pay for care? It's all very, very expensive, as you already know. And so one of my questions is there a chance that you could outlive your assets? And usually that answer is yes. So we need to talk about Medicaid and what it is, again, what it pays for and how you qualify and all of that. So just wanted to do a review of that throughout, you know, the rest of this segment and throughout the rest of the program today. So it is a federal program, but the money is distributed to the state, state by state. So there could be some state differences , in , in in some of the rules. But I'll tell you what, they're all very, very, very similar. Okay, but you could have some rules that are different, and it and it could be it could make a substantial difference, and I'll touch on that here in just a little bit. So, how do you qualify for Medicaid? I've had so many people, they're just so misunderstood. Oh, we make too much money to qualify for Medicaid. Well, what is your income? Well, it's $2,500 a month. I said, nope, you you're just fine. You don't make too much, you could qualify. And so and they're just people are just so surprised about some of these things. So let's talk about it. So you have to look at income is important. If you're okay, I'm getting I'm getting out of out of order here, but if your income is more than the monthly cost of a long-term care community, you don't qualify. Well, that makes sense. So if the place is ten thousand dollars a month and your income is ten thousand five hundred dollars a month, you don't qualify for Medicaid because your income is more than the cost of your care, therefore you can just pay it out of pocket, right? So I mean that makes sense. The I I've only met maybe one person. That's been years ago, and his income was literally like a few dollars higher than the monthly cost, okay? And so what we did was you know, we looked at some other long-term care communities where their Medicaid reimbursement was a little bit lower than that. So excuse me, but it was a little bit little bit higher than that. So his income ended up being lower than that, and then we can get in qualified because he didn't have any other assets to make up the difference, and so it was all income-based. And so for him that worked out, and that was the right thing to do for him. Anyway, I'm getting so far off of the topic. Let's jump in here. So we're looking at assets. I could talk about this stuff for hours, by the way. So we're looking at your assets, and you look at your assets, and then we're going to put them into two categories. So, exempt assets, meaning they're protected from Medicaid. Okay, so your exempt assets would be your house. And I'll say for now. There's a little bit of a catch to that, but your house is exempt, your a car is exempt, a prepaid funeral plan is exempt, a small amount of cash value in a small life insurance policy is exempt, and then household goods, all the stuff in your house. So those are the exempt assets. So the countable assets, just think almost everything else, just think liquid assets, checking, savings, mutual funds, money markets, CDs, IRAs, 401ks, all of this stuff. Okay. So we are going to look at the at the countable assets, which means you're going to have to spend those assets on yourself on things that benefit you. Of course, pay for your care. You're going to spend those assets, whatever that number is, you're going to spend down to the trigger point, the qualification point. And in Missouri, it's $5,909. In the state of Kansas, it's $2,000. Once your number of assets, what let's say it's $50,000, it could be whatever the number is. Once you spend that down and you hit $5,909 in Missouri, $2,000 in Kansas, you're qualified. It is this is just a simple asset test. Now, what can you use that money on the spend down? What can you use that for? Well, obviously, you pay for the cost of your care. You can pay for legal fees, which I'm a I'm a huge fan of. I'm a big proponent. Work with an elder law attorney. This is the perfect opportunity to update your power of attorney documents, get a new living will in place, ,, get, you know, a trust in place. , do all the things and get qualified, you know, have them maybe handle the Medicaid application, all the things that they do. That can come right out of this spend down. Again, you can buy a prepaid funeral plan, which is a very smart financial thing to do. You take cash, which is a countable asset, and invest that into a prepaid funeral plan. Now your final expenses are done and it's exempt. You can pay off debt, you can make improvements to your home, you can upgrade your vehicle. So there are a lot of things you can do, but the bottom line is once you spend that down to the qualification point, you are qualified. And I'll have a whole lot more about this important subject coming up next.

Speaker 2 32:42

You're listening to Senior Care Live on the Senior Care Broadcasting Network. To contact Steve or a guest on his show, visit SeniorCareLive.com. We'll have more coming up.

Speaker 33:01

Have questions? Visit SeniorCareLive.com. Back to the topic of Medicaid. So I just explained what happens if you are a single individual and you have X dollars, you have exempt assets, you have countable assets, you'll spend down to that $5,909 in Missouri, $2,000 in the state of Kansas, and boom, you are in. It's just it's that simple. It's very straightforward, actually. But what happens if you are a couple and one spouse needs long-term care? The other spouse is still very independent, living in the home, and doesn't plan on moving. But they plan on visiting their spouse every single day in long-term care. They love them, they miss them, but they're going to stay home. I've worked with so many couples in this situation. And so what they've done is they've worked with an elder law attorney to do something called the division of assets. So back in the day, long time ago, long time ago, and this is just terrible, people would get actually get divorced just to protect half of the assets for the at-home spouse. And that that's a horrible, that's just a horrible thing to do. So Congress came up and said, Well, wait a minute, we're the United States of America. That seems that seems kind of crazy. Why can't why can't we just divide the assets on paper? So and don't get divorced. And so the division of assets was created to just div just do that, divide them on paper. So let's say you know a couple has you know X dollars in countable assets. You put in let's say it's , but John and Sally, for example. John needs nursing home care, long-term care. Sally's at home, so you put half on his side, half on her side. So her side is protected. And then on John's half, then you have that spend down, whatever the dollars are. Let's say it's $100,000, whatever the number is. Again, you spend that down to $5,909 in Missouri, $2,000 in the state of Kansas, and boom, he's qualified, and you have essentially protected at least half of the assets for Sally, because she still pays electric bills and water bills and , repairs the roof and you know, all the stuff. She's still independent and has all the costs. So on his spend down, again, you can pay for his cost of care, pay for legal fees. That's the best money you'll ever spend working with an elder law attorney to accomplish that division of assets in an effort to protect the assets as much as possible for the at-home spouse so that, and the law says, so that the community spouse does not become impoverished due to the cost of long-term care. So they can do that. They can do it properly, they can do it legally, where it doesn't cause any problems, it causes no penalties, et cetera, et cetera. They'll do it right. It's the best money you could possibly spend in this situation. So the legal fees can come off of John's side on that spin down. Placement fees, placement service. This is just a shameless plug for senior care consulting. But so we work with so many people who are actively on that spend down and they're like, look, Steve, we have, you know, X dollars, and these dollars are spoken for. They need to go , for you know things that benefit the person needing long-term care, right? So they pay for the cost of care, legal fees. They could also spend just a small amount of that and hire senior care consulting to make sure they get the right place and the best fit and the best place available. And they're like, hey, that's that's kind of a no-brainer, Steve. And so and a lot of people see it that way. You can, again, pay for a prepaid funeral plan, pay off debt, home improvements. You can make improvement in the house. Sally's still in the house. We need a $10,000 HVAC system, pay for it off of John's side. That is allowable. You can buy a new car or buy a newer car to make sure Sally can get back and forth with reliable transportation. All those things are allowable, perfectly legal to do. And so again, that's that division of assets. And I'll tell you what I said earlier in the last segment, I said sometimes you can have some differences in in state rules and regulations. And they're all very, very similar. But here is one, particularly in the Kansas City metropolitan area, that sometimes can pay off big time. And in fact, I am currently working with a very nice lady. She's living at home. Her husband needs long-term care. She lives in Missouri. In Missouri, her 401k IRA, all of those things are countable, and you'd have to split them in half. She would lose half of all of that. She's worked her entire lifetime to build this retirement up. She could she could lose half of it if she placed him in Missouri, because that's just a Missouri regulation. Well, guess what Kansas says? Kansas looks at that a little bit differently. And Kansas says the retirement accounts, so 401ks and IRAs, those are the two main ones. You have 403Bs and some others, but the retirement accounts of the at-home spouse, all of that money that is exempt. Let me say that again. If you're in Kansas and the at-home spouse has, say, a half a million dollars in a 401k, they worked a long time to build that up, that's off the table. You don't have to split that in half, like you do in Missouri. So guess what we're doing? This lady says, you know, I'm I'm no spring chicken, Steve, but I'll drive to Kansas to see my husband if I can protect these assets that I worked my entire life to build up. I really can't afford to lose them. So they live in Missouri, they have property in Missouri, but we are going to work to find a Kansas long-term care community to provide his care. And if he is in Kansas, even though they live in Missouri, they have property in Missouri, the Kansas rules apply. That is one difference in the state regulations that could make a huge financial impact positively for the at-home spouse. I've worked and it's perfectly legal. I've had all kinds of people argue with me. Well, Steve, if they're in Missouri, they can't move to Kansas. Oh, yeah, they can. Well, you have to establish residency. No, you don't. No, you don't. Here's what the law says. If you move to the state of Kansas from any state, okay, on day one, when you move in to that Kansas long-term care community, with this is the key, with the intent to stay, obviously he's going to stay, receiving all the care, you are immediately a Kansas resident. And the Kansas rules apply, even if the spouse lives in another state. It protected hundreds of thousands of dollars that she will need to live, continue to live independently in their home. Okay? So and gosh, I don't I maybe I'll talk about it next time. I don't have time to talk about what happens with the income, but let me just give you a kind of a teaser. John moves to the nursing home, and John's income follows him to the nursing home. She is going to take a big discount, a big hit, a big deduction or reduction in monthly income. So this is all important. If you have questions about this, if I got your attention about the Kansas rules apply, you want to talk about it, see if that works for you. 913-945-2800, Senior Care Consulting at 913-945-2800, or visit online at SeniorCareConsulting.com. Again, thanks to my friend David Wiley for talking about the important subject of the fraud and abuse and how it's being addressed. That was excellent. What a great show this was. I'm Steve Kuker and I wish you grace and peace. May God bless you and your family on this day and always. Join me next week, right here on Senior Care Live.