Family Caregivers – When Is It Time For Assisted Living?

We live in an age where we, as baby boomers are put in the role of caring for our elderly parents. Technology and medical advances have, in many instances, extended the lives of human beings. However, the extension of life does not necessarily equate to the extension of health. As our parents age, they are increasingly vulnerable, unable to make decisions easily, require assistance in caring for themselves and have difficulty keeping up their home. Parents used to be our caregivers, but now the roles are reversing and many of us are now caring for our elderly parents. At the outset of their declining health, we want to keep them at their homes where they are comfortable. And, typically, they want to stay in their familiar surroundings. So, we make arrangements to give them the care that they want. But, when is it time to make the decision that home caregiving by the family can no longer be sustained and it is time for assisted living? This, of course, depends on the family and the health of the parents. Eventually, though, it won’t be a single incident or a long discussion with other family members. Something inside of caregivers will say “it’s time.”

Family caregivers go through a range of emotions and stress when taking care of parents in need. The family usually makes the decision to keep the loved ones at home and work together to take care of them. But, this type of caregiving takes a lot of coordination and can be very time-consuming, particularly if there is only one caregiver. Your everyday life is turned upside down and caregiving can put a strain on your marriage, your relationship with your own children and your finances. In addition, if you have siblings that are not helping (or think they are but really aren’t), this puts a strain on your relationship with them. You become resentful because your siblings continue to lead their normal lives and you, either by choice or by process of elimination, are shouldering the “burden.”

Then there’s the guilt. The guilt of being angry at your parents because you have to tell your spouse and children you can’t do something with them because you have to tend to your parents. The guilt of wanting to move to another state, but you can’t leave your parents and you resent them for not being able to move. The guilt of being impatient around your parents and lashing out at them with frustration. And the guilt of feeling like you are a failure at taking care of them and that the care you give them is not adequate.

We all have our limits. You will know deep down when you have hit your limit because you can no longer physically or emotionally care for your parents. Whether you are caring for them in their home or if they have moved into your home, you will know. You will get to the point where their physical or mental needs are not being met by you. They might be falling frequently, or their dementia has gotten to the point where they need constant medical attention. You always told yourself that it is in their best interests to keep them at their home or your home, but now you are realizing that their best interests are with full time assistance from professionals. You may have promised them over and over again that you will take care of them and you will never put them in a “home.” But their age and health has come to the point where they either need assisted living or need full time professional care at home. Depending on their finances, full time home care may not be an option. Guilt, stress, strain, finances, promises, other alternatives – these are all considerations that must be dealt with when making the decision that your parents will be better off in assisted living. And once you have made peace with the fact that you can no longer do it and that they will be best served by professionals, a small voice will come from within and tell you “it’s time.”

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Medicare Versus Medicaid – A Big Difference for the Elderly

Despite the similarity in the words, Medicare and Medicaid are two very different health care programs.  Medicare and Medicaid affect the elderly in different ways.

Medicare vs. Medicaid

Medicare is a federal health care program for people over the age of 65 and those people with disabilities who qualify for Medicare insurance. There is no other qualification. Income level does not matter with Medicare. Medicaid, however, is run by each state (with assistance from the federal government) and is a health care program for lower income people. Each state creates its own Medicaid program based on federal guidelines. Unlike Medicare, where benefits are automatic at a certain age, you have to qualify for Medicaid benefits.

This difference becomes very obvious when you are moving a loved one into assisted living. Medicare, the federal health insurance program, does not cover assisted living. Medicaid does. However, Medicaid requires a person to have a certain income and asset level in order to qualify for Medicaid payments to assisted living centers. Each state is different. For example, in Michigan, the asset level is $2,000.00. Again, Medicaid is for people with little financial means.

Assisted Living and Medicaid

If assisted living is required with your loved one and they do not qualify for Medicaid, then payments to the assisted living center come from personal income and assets. Medicaid requires you to “spend down” these assets until they reach a certain level before Medicaid begins paying. There are certain exempt assets, such as a home, a car, etc., but if your loved one has an IRA, savings account, stocks or any other assets, payments to the assisted living center come from your loved one’s income and assets first. This can financially devastate a family. So, the more time you have to plan for a loved one’s move to assisted living, the better. There are ways that you can decrease the amount of assets, but Medicaid typically has a 60 month look-back period, meaning they will look at all of the asset movement for the past 60 months to determine whether it was a legitimate transfer or whether the asset should be included as part of your loved one’s assets. The Medicaid rules get very tricky, so if you think that the government is going to help pay for your loved one’s stay at a facility, you need to become familiar with Medicaid rules in your state and perhaps seek an attorney for some estate planning for your loved one.

Some individuals are eligible for both Medicare and Medicaid and they are called “dual eligible.” For those that receive both coverages, most of their health care costs are covered. Medicare pays first, then Medicaid will pick up most, if not all, of the balance.

Ombudsman Program Helps Protect Long Term Care Patients

Ombudsman Program

Many people don’t know that there is a federal law, called the Older Americans Act, that requires every state to have an Ombudsman Program. The Ombudsman Program addresses complaints by residents of long term care facilities related to treatment, conditions, and abuse of those in long term care facilities. Family members of long term care residents can also complain to an Ombudsman regarding the level of care their loved one is getting.

 

What is an Ombudsman?

An Ombudsman, usually a volunteer, receives complaints regarding long term care and helps resolve those complaints. The Ombudsman works with both the resident and the facility to come to a peaceful conclusion. Communication between the Ombudsman and the person complaining is usually considered confidential and cannot be disclosed.

The Ombudsman can also hear complaints of physical, verbal or mental abuse, in the event a resident does not have anyone else to turn to or in the event a family member suspects the resident is somehow being abused. However, care must be given that a volunteer doesn’t overreach and get personally involved with family matters. When an Ombudsman gets involved in family fights or family matters, this should be outside the scope of his/her responsibility and should be reported back to the Program director. The Ombudsman is not there to referee family matters. Family fights should usually be resolved between the family, the court system or the state human services department.

In addition to resolving conflicts between a resident and a facility, the Ombudsman Program educates people on a resident’s rights, and advocates for a resident’s rights and quality of care, personal care and residential care. The Program also provides information to people about locating long term care facilities and what you should know to get quality care.

Usually, each state has local offices to help run the program, sometimes called the Commission on the Aging, Area on the Aging, Administration on the Aging, etc. If you contact your local township or city hall, they will most likely have the information you need to contact the local Ombudsman Program.   The National Council on Aging website is an excellent resource to learn more about the various aging programs.

The Different Levels of Elder Care Facilities

Whether you are thinking about moving to an elder care residential facility or worrying about moving a loved one to a facility, researching is the key. The research process can be long and stressful, so here are some helpful definitions to get you started.

  •  Independent Living

    This is a type of senior living where a person lives in an apartment-type complex. The complex has security and usually offers its residents transportation, group activities, and cafeteria style eating. Health care services are minimal. Laundry services can also be included.

  • Assisted Living

    This is also apartment-style living with group activities, food services and security. But this type of facility also provides basic health services. Skilled nursing (a level of care provided by trained persons such as RNs, physical therapists, etc.) is usually not included. Laundry services are usually included along with assistance in bathing and dressing.

  • Skilled Nursing Facility

    This is also known as a nursing home or a convalescent home where residents receive 24/7 care by licensed professionals. Housekeeping and laundry services are usually included, as well as bathing and dressing assistance.

One popular and emerging type of elder facility is the Continuing Care Retirement Community. A typical community of this type includes several residential complexes. A person in declining health can live in the independent living section of the complex, then as his/her health deteriorates, the elder can move to a different residence in the same complex that provides more and higher levels of health care assistance.

Medicaid for Parents Going Into Assisted Living

What is Medicaid?

Medicaid (not Medicare) is a federal/state health program for the needy and low-income. The rules are state-by-state and many of us are now looking at Medicaid for our parents that have little to no assets and who need to be in either assisted living or full time nursing care.

Each State has Different Medicaid Rules

The Medicaid rules in all states are very detailed and hard to follow. But, safe to say that there are two eligibility requirements – income and assets. There are assets that are counted by Medicaid and assets that are exempt. For instance, in Michigan, a person can own only $2,000.00 in assets to be eligible for Medicaid, and a person’s primary residence is exempt – not counted – in the total assets. If the assets exceed the minimum, a person must personally pay for the assisted living or nursing care until the assets reach that level.

Income levels are another eligibility requirement. Most, if not all of a person’s income, is paid directly to the assisted or nursing care facility. Again, the requirements go by state.
The cost of assisted living and nursing care facilities also vary by type and by state. The costs can be $4,000.00 per month and up, depending on where you live, the type of facility and the level of nursing care needed by the ailing person. The best thing to do is, when it is getting harder for a family to take care of an ailing person on their own, begin to check out some of the facilities for cleanliness, level of care, cost and waiting time. Some of the better facilities have a waiting list and, if you will need Medicaid, only a certain number of beds may be allocated to Medicaid patients. Don’t wait until the last minute, especially if you can do your research now.

Medicaid Recovery after Death

If you are able to qualify for Medicaid, there is another caveat that you must watch out for after death, and that is Medicaid recovery. States are required to seek recovery from a person’s estate for payments made by Medicaid. Some states seek repayment in an aggressive manner, but some states don’t make a big effort in the recovery process. In any case, remember that it is the person’s estate from which Medicaid can seek recovery. So, if there is nothing in the estate – nothing that needs to go to probate court – there is no recovery to seek. One of the main items of recovery is a person’s primary residence. If the spouse is no longer living, or if there is no spouse, and the house isn’t deeded to another person at the time of death of the Medicaid recipient, the house will most likely go to probate court and the state could file a claim to recoup its money. In these instances, it is best to put someone else’s name on the deed. Many states call the deed different names – transfer on death deed, beneficiary deed, ladybird deed, etc. With these types of transfers, upon death, then the house automatically goes to the other person listed on the deed. This avoids the house going into probate, and consequently, avoids a recovery claim by Medicaid.