Massachusetts Estate Planning & Asset Protection Blog

Massachusetts Elder Care Attorney | In Home, Assisted Living, or Skilled Care? What Should You Consider?

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Fri, Oct 05, 2012

How Should You Spend Your Money?
The Delicat
e Balance of Care Options: 

In Home, Assisted Living, or Skilled Care?  What Should You Consider?


Seniors all around the country are concerned about their future,especially finances and health care.  The stock market,  investments and retirement accounts have fallen in recent years, but medical and nursing home costs continue to rise. Americans today are living longer than ever before. On average, those who reach age 65 can expect to live well into their eighties. In fact, the average life expectancy in the United States recently reached an all-time high of 78.7 years and the Census Bureau estimates that in the near future the average life expectancy will be into the low 90’s. This blog discusses in home, assisted living, and skilled care to help you decide which care option is best.


Click Here to Download the Senior & Boomers Guide to Health Care Reform & Avoiding  Nursing Home Poverty


When you or a loved one become unable to completely take care of yourself, the question, "What care option is best?" becomes important to answer. While it is important to consider one's personal  needs and desires, it is equally important to consider what the future may hold in terms of changes in the type of care needed. With care being so expensive today, you may want to look into applying for VA benefits or Medicaid or some newly available community resources to help pay for your care.  There are a number of options available so it is might be time for some careful consideration and planning for the care that may be needed at some point during your lifetime. Perhaps NOW would be a good time to consider that you may need to take personal responsibilty for some costs that may be facing you and your family at some point during your lifetimes.  The following is meant to help you understand in more detail what needs to be considered as you evaluate your options.assisted living, medicaid, in home care


In Home Care

One option people tend to start with is an in-home caregiver. You can obtain an in-home caregiver either independently, or through an agency. If you have a non-agency caregiver for which there is no record of payment, as many people do because it can be more cost effective, it is vital that you enter into a written caregiver contract with that caregiver. This will allow you to prove to VA, and eventually Medicaid, if needed in the future, that this caregiver was paid at fair market value and at a certain amount per hour. You must also obtain the necessary medical opinions indicating that the caregiver is a necessity, and then document the caregiver expenditures. Once there is a physician's opinion, a contract in place and documentation of the caregiver expenditures, a VA application or Medicaid application.  You will be better positioned to submit. 

VA Benefits May Help

It is important to know that, in order to qualify for VA Aid & Attendance benefits, your unreimbursed medical expenses must exceed your income. For example, if you have a monthly Social Security income of $1,800, and pursuant to the caregiver contract, you are privately paying a private caregiver at the rate of $15 per hour for 40 hours a week, the result is a monthly expenditure of $2,400 per month. This would more than offset your $1,800 per month Social Security income, thereby potentially enabling you to qualify for maximum VA benefits of about $1,700 per month.  It is important to note that a Bill has been proposed that would add a 3-year lookback period, making it more difficult to qualify.  The window of opportunity is closing and it is critical that you act now if you think you qualify.


How Long is Too Long to Spend Monies on In Home Care?

Let's say you have an in-home caregiver and have been paying them for a while. The question now becomes "How do I plan for the day that I run out of cash, and require either assisted living or nursing home care?" The problem with in-home caregivers is that you can expend all of your monies with them. When you run out of assets with a caregiver at home, you will not have built any goodwill with a Medicaid facility, which you are now asking to care for you for the rest of your life. It is important for you and your family to understand that at this point, while you may want to stay at home, if all of your funds are depleted from paying for an in-home caregiver and your health is declining, then you will subsequently have no money to offer as "key" money to a facility, either assisted living or skilled care, when and if you need to move from home to a higher level of care.


Can You Stay Too Long in an Assisted Living Facility?

Going to an assisted living facility may not be the answer either, though. The result can be the same in an assisted living facility as it is with the private caregiver. Once you run out of money at an assisted living facility, they will ask you to leave. All the goodwill you built with the assisted living facility becomes worthless when you then enter a skilled care facility, to which you now have no money to offer, and with which you have the eventual hope of Medicaid eligibility.


A Balanced Approach

A better approach would be to balance the situation by staying at home with a caregiver, or staying in an assisted living facility, as long as possible, but not spend down to the point where you do not have at least enough assets to cover one year of private pay at a Medicaid skilled care facility in order to make yourself an attractive candidate for the facility of your choice.


Thus, while the extra $1,700 per month from the VA may help keep you at home longer, don't stay at home or in an assisted living facility too long, putting yourself in the position to not have available monies to make you an attractive candidate for a skilled care facility. Keep in mind that a skilled care facility may eventually take Medicaid, and you may need such a higher level of care in the future, which can be very expensive.  This will require some initial "key" money payment to the skilled care facility. This is a very delicate balance that you can only achieve with your eyes wide open and with sensitivity to your wishes, while also being circumspect about protecting yourself now, as well as in the future.


At the Estate Planning & Asset Protection Law Center of Dennis Sullivan & Associates, we help people and their familes with our unique conseling & educational process.  Our process starts with a health assessment designed to help people better understand their options as well the time frame in which they'll likely need help, whether at home or in an assited living facility.  Our team of professionals then evaluates the families options based on their health needs and financial circumstances and help determine which significant resources may be available. In some cases we can even help people qualify more more resources than they thought would be available and are able to help people qualify for resources much sooner than they would otherwise have been able. 


For more information on how our team of professionals can help you, call (781) 237-2815 today.  We also invite you to attend one of our free educational Trust, Estate, & Asset Protection Workshops.  Seating is limited and registration is required.  To register Click Here or call (800) 964-4295 (24/7).

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Tags: Estate Planning, Medicaid, Nursing Homes, elder care, assisted living, veterans benefits, VA benefit, Massachusetts, caregiver, in home, skillled care

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