Know the Basics to Decide on Long Term Care

Senior living arrangement choices have changed dramatically in the sixteen years since I first began practicing elder law. Back then, there was generally a single choice between assisting parents at home or their going to a nursing home. Now there are multiple variations. The choice in the past was difficult with almost all home care provided by family members many of whom quit their jobs or juggled child raising and parent care responsibilities. That continues but there are also multiple services now to provide both non-medical and medical in-home care. Companies  providing home care for seniors have become an important part of the equation. If you decide to retire in your own home, you may need to install a chair lift machine and invest in other modifications like a Home Chair Lift for Stairs to make it more ideal for senior living.

Sixteen years ago some families in the higher asset range opted for Continuing Care Retirement Communities where seniors could buy in to a contractual arrangement for an apartment or cottage with a lump sum buy-in. Residents would step up to a higher level – personal care (assisted living) or skilled care – on the same campus if they needed it later. That arrangement continues with more communities and more flexible payment arrangements than before. Skilled care in a CCRC might be Medicaid certified or the resident might have a negotiated rate until assets are exhausted but, in any event, the idea is that he or she will continue to be cared for even if personal funds have been depleted, provided he does not give his assets away.

Personal care homes have exploded over the past 14 years with multiple communities and alternatives. At the same time, partly because of government incentives to contain Medicaid costs, the number of Medicaid skilled nursing beds has steadily decreased. I would be as likely today to see a family dealing with at-home or CCRC or personal care/assisted living care as I would be to meet a family considering skilled nursing in a Medicaid certified facility. Even in assisted living there are now several levels of care. With major differences in levels of care, pricing, availability of government benefits, and regulations between personal care/assisted living and nursing home, there are more choices than ever before. “Memory Neighborhoods” and secure dementia units have blurred the differences even more. Here are some thoughts.

Differences in Cost. Both assisted living and skilled nursing are “pay as you go.” Skilled nursing is typically much more expensive than base assisted living. However, if you continue to add services – feeding, bathing, dressing and others- to the basic personal care home/assisted living charge, personal care can become as expensive as nursing home care. It is not unusual for monthly base charges in personal care/assisted living to run $5,500-$6,000 per month. Personal care/assisted living with substantial additional services, as indicated, might even include a personal companion for the individual resident and could cost as much as skilled nursing. Skilled nursing in Chester County and other Philadelphia Suburban Counties may cost $8,000-$9,000 per month.

Availability of government benefits. As of this writing, the only significant government benefit available for personal care/assisted living residents is the Veterans’ Aid and Attendance program for wartime Veterans and their widows or widowers.

An earlier movement in Pennsylvania to allow Medicaid to cover assisted living residents has essentially been abandoned.

Some families begin in personal care/assisted living expecting to move to skilled nursing under Medicaid when the funds run very low. For more reasons than can be explained here, this is a bad idea. Application for skilled nursing should be made while the potential resident still has enough available funds to make him or her an attractive candidate for admission to the skilled nursing facility, even one that takes Medicaid.

The Medicaid rules are complicated and became more so on February 8, 2006 with changes in federal legislation but much more can be done for some families if they seek help earlier, especially when they have the funds to plan. Also, since innocent payments to adult children and others could result in disqualification for benefits for care, actions should be considered and decided in advance. Filial responsibility where adult children might be sued for the cost of their parent’s care when funds are exhausted has become a concern. There are problems that can be corrected if recognized early enough and these issues may be addressed by planning ahead.

For more, listen to “50+ Planning Ahead” a weekly radio program on WCHE 1520 on every Wednesday from 4:30 pm to 5:00 pm with Janet Colliton, Colliton Law Assocs., PC, and Phil McFadden of Home Instead Senior Care.

About the Author Janet Colliton

Esquire, Colliton Law Associates, P.C. Janet Colliton has practiced law for over 38 years, 37 of them in Chester County, Pennsylvania, a suburb of Philadelphia. Her practice, Colliton Law Associates, PC, is limited to elder law, Medicaid, including advice, applications and appeals, and other benefits planning including Veterans benefits, life care and special needs planning, guardianships, retirement, and estate planning and administration.

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