Whenever I ask a group of senior citizens whether any of them would rather receive care in their home or in a nursing home they – without exception – indicate that they would rather stay in their homes. This makes sense when one considers that “a man’s home is his castle.” This is the dwelling that these persons spent most of their lives enjoying and maintaining and no one would choose a foreign environment in exchange.
Hence, it pays to plan ahead to prepare for a time when one needs long-term care so that the care can be received in the home. What are the options to pay for home care?
1) Private Resources – Income from social security will rarely be enough to pay living expenses and the cost of care. Custodial care for those recovering from acute or ongoing chronic health issues can cost in the range of ten ($10) to twenty ($20) dollars an hour. Retirement funds from and IRA or other similar retirement plan can help to supplement, but only when the amount of care needed is limited. Unless an estate is extremely large, other ways of paying for care must be explored;
2) Help from Family Members – If there are sufficient family members who can provide labor and/or financial support this can enable the older person to remain in the home for an extended period of time. However, in an ailing Michigan economy this option is dwindling as families struggle to cope with rising costs.
3) Medicaid – The Home and Community Based Waiver program is administered by various service providers, including but not limited to the Area Agency on Aging. It is Medicaid’s alternative to care provided in a nursing home. As with the Medicaid program for nursing homes, there is an asset and income test and a medical eligibility test. Applicants must have incomes at or below 300 percent of Supplemental Security Income; those who are Medicaid eligible, because they are medically needy, must first spend down each month to the community protected income level. Hence, a person with any substantial assets or income will not qualify. Those who do qualify will be eligible to receive nursing care in their homes.4) Veteran’s Benefits – Those who had at least 90 days of active military service, with at least one day during a “period of conflict” can qualify for a pension to help pay for the cost of care to provide assistance with the activities of daily living. The benefit will pay for assisted living as well as home care. This is a very overlooked option that could – when combined with social security and other income – provide an adequate source of payment for care in the home.
5) Medicare – In the event that a doctor can certify that the person is struggling with a terminal illness, hospice care can be provided in the home. This care provides only palliative rather than curative care; however, such comfort care can be all one needs as a terminal illness progresses. Medicare will pay for the cost of hospice care, as will some private insurance.
6) Private Insurance – Most long-term care insurance policies have an optional rider that guarantees that funds will be available to pay for the cost of home care. Those buying policies should be sure to obtain this rider or the cost will be paid only for institutional care in a nursing home.
Many of the benefits mentioned above are available only if the person seeking the coverage for home care meets an asset and income test. A qualified elder law attorney can help individuals qualify even if they are initially over the asset or income limit, thereby preserving, maintaining and extending resources for use by a spouse, children or heirs. A proper estate plan is the solution.
Family caregivers should start the process of homecare by taking steps as follows:
1. Talk about the various homecare options with the person or persons who will be needing such care to make sure they are comfortable with the approach;
2. List the various types of care that will be needed, for example, is the person struggling with Alzheimer’s disease where progressive oversight will be needed over a period of years? Then, seek to find the best provider of the various levels of care that will be needed as the patients needs change.
3. Investigate the homecare providers available, get estimates on costs, and list what types of payment are available for each service needed.
4. Consider meeting with a geriatric care manager to assist in the steps listed above and outline a plan to insure adequate preparation.
5. Decide whether the care will be provided through a homecare agency or through volunteer family members. If an agency is desired, make sure it is Medicare certified and check whether the services needed would be paid for by Medicare, Medicaid or whether other sources of financing are available.
6. Meet with an elder law attorney to review existing estate plans or create a new one that will preserve the estate while permitting the person to qualify for government benefits.
Homecare is the most desirable option for seniors struggling to maintain a comfortable environment, proximity to loved ones and a degree of independence. However, the cost of such care can be almost as expensive as the staggering costs of nursing home care. Elder law practitioners and other professionals can assist families in obtaining the financial coverage available while preserving, extending and maintaining estate resources. Working together, we can insure that the desires of our senior population to stay in their homes as long as possible becomes a reality