Long-Term Care for the Elderly
"Twas sunny skies
whilst Noah built his Ark…"
recent months, this office has rendered legal services to a
record-high number of families with a single common denominator:
an elderly member can no longer take care of himself. Apart from
the heartbreak of such a realization, and, at times, that
realization can come a bit late, there is the daunting task of
dealing with all of the issues commensurate with the problem.
With so many elderly living well into their nineties and beyond,
affordable, safe and pleasant home surroundings are at a greater
demand than ever. Ordinarily, the elderly prefer to remain at
home. In fact, I have never met an older individual who actually
opts to leave the familiarity and comfort of her own home to be
relocated to a long-term care facility.
However, there are times where the demands of a physical illness
or injury, or a mental illness or senile dementia, render the
option of relocation to a long-term care facility a better
option than home care. When one adds financial constraints, it
can seem that the elderly have little choice in the matter.
Home Health Care
most common scenario encountered by this office presents as
follows: a couple, or just widow or widower, is currently living
alone in the family home. The children are out of the home and
on their own. All is well until something happens, such as a
fall or stroke or like event, which creates challenges that the
elderly cannot meet. Whether the event is dramatic, or just
evolves with time, at some point seeking help for the elderly
becomes a necessity.
family homes are latent with dangers."
Unquestionably, family homes are
latent with dangers. For example, if my eighty-nine year old
widowed mother needs to recover from knee surgery, without help
she cannot do it; not in her home (where there is only one
bathroom on the third floor) or my home (where we have
twenty-seven steps in the house) or my sister's home (a small
studio on Central Park West.)
Obviously, the above example is a temporary dilemma, and many
families make due by pooling their resources over the short
term. In the example above, I might work out a schedule with my
sister and our respective husbands to assist Mom in her recovery
in her home. We would have to rent a commode for the main floor
of the house, and hire a home health care worker to take care of
Mom during the overnight, when necessary. Medicare will probably
not pay for that home health care worker, so those services
would have to be paid privately until Mom could be made eligible
Mom qualifies, Medicaid would pay for services in the home which
have been authorized by that agency. If Medicaid does not cover
all the services required, the family can supplement with
private paying for additional services without jeopardizing her
Medicaid is governmental health insurance for individuals whose
assets fall within certain parameters. Assets include income
(pension payments, social security, bank interest and the like)
and resources (bank accounts, insurance, brokerage accounts and
the like.) In order to qualify for benefits, the Medicaid
applicant's monthly income may not exceed $725.00 and resources
may not exceed $4,350.00; a married couple's income may not
exceed $1,067 and their resources may not exceed $6,400.00.
If an individual or couple qualifies for Medicaid, they may
receive assistance for home care, apart from other services, but
probably not for twenty-four hour care. On its face, this type
of medical assistance is designed for the needy, and is
ordinarily not much help for working class families.
Frequently, families do just fine working within these
parameters in the short term. But what about a different
situation, say one like my Uncle Sal's earlier in the year? He
had a major heart attack at ninety-one years old, and the
prognosis was grim. He simply could not ambulate on his own; he
could not take a shower or even make a snack by himself. When
alone in his home, he became afraid to allow anyone inside,
including a home health care worker. As a result, the family had
to find an appropriate long-term care facility. It settled on a
well-known facility in Westchester that charged $14,000.00 per
month, and the family privately paid for a month until he passed
away. But what if his prognosis had been better? How long would
his life savings have lasted at that rate, and could the family
count on financial assistance from anyone?
Financial Considerations and Institutional Care
it is true that individuals are admitted to long-term care
facilities because of physical or mental conditions that make
remaining in the home impossible, it has been my experience that
just as many cases, if not more, are based upon financial needs.
Why? Because Medicaid allows a husband and wife to retain a lot
more assets (income and resources) if the ailing spouse is in a
facility and the well spouse remains in the community.
allows certain exempted property: a family home,
automobile, funeral and burial fund, among other
In an attempt to avoid the total
financial ruin of a middle class couple faced with institutional
care costs, when an ill spouse qualifies for Medicaid as
indicated above, the well spouse living in the community may
have monthly income of $2,610.00 and resources of $104,400.00.
In addition, Medicaid allows certain exempted property: a family
home, automobile, funeral and burial fund, among other assets.
In certain situations, a spousal refusal may be appropriate. In
short, that means that a well spouse refuses to support the sick
It is not difficult to see why families opt for institutional
care. Sometimes they really have no choice.
Planning is Crucial
the above scenario appears bleak, it need not be. Some people
opt to purchase long term care insurance, and others opt to see
an attorney before the situation becomes emergent, and others
opt to do both. Elder attorneys consult with clients and prepare
plans everyday. For many families, it is the best investment
they can make. Our next issue of the Newsletter will focus on
various options to planning and the transfer of assets, spousal
issues, and long-term care insurance.
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