What to know before bringing your parent home
When an older parent leaves the hospital today, she or he might first go to a nursing home or rehabilitation facility for follow-up therapy. Medicare, along with a private Medicare Supplement insurance plan or a Medicare Advantage plan, might cover the cost for up to 100 days. Often the time is less, sometimes in the range of four to six weeks.
If, after this, your parent is strong enough to return home and live independently, then the issues discussed here may not apply. When that is not the case and you are the adult child of a parent who might not safely live home alone, then this message is for you.
The direction has been, over the past several years, to emphasize the desirability of continuing to live at home. The Commonwealth of Pennsylvania has stated that its studies show the majority of elderly would rather live at home than in a nursing home or assisted living. The funds could have been better spent since almost anyone would say they would rather be home.
I said “almost” since I have had clients, all of them women, who confided to me they would rather be in assisted living or nursing home care than have their daughters and sons need to spend as much time and effort as they did caring for their own parents.
Most people would rather be independent than dependent, well than sick, or at home than in a community of mostly strangers who might also be unwell.
On the other hand, going home when ill may be difficult to handle particularly when the person suffers from later-stage dementia. It might even be unsafe and patients might be unable to cooperate with a plan of care.
Some myths need to be dispelled before making an informed decision what to do next. Here are a few.
The myth that it is less expensive and easier to care for a person at home. At-home care is less expensive and not so time consuming — if the patient is relatively well. If 24-hour, 7-day-a-week intensive care is needed, at-home care is more expensive than nursing home care. For some, it might be the preferred choice but it is not necessarily inexpensive.
The myth that government pays for everything. The fact that government encourages people to stay home does not mean that it pays for all or even some of it. The most expansive government at-home program for most people is the PDA (Pennsylvania Department of Aging) Medicaid Waiver Program.
Veterans programs and hospice are other possibilities. To qualify for PDA Waiver, you need to be over 60, have less than $8,000 in countable assets not including a house, car and personal belongings, and have income including but not limited to gross Social Security, pensions, and investment income of no more than $2,022 per month.
If you have one penny more in income, you do not qualify. You also have to demonstrate, with some exceptions, that you did not give away assets during the five-year period prior to the time you are requesting care.
You or someone on your behalf needs to complete the forms for the program and supply the required documentation, agree to be subject to the Medicaid estate recovery program after your death, be interviewed to determine your plan of care, and be approved. Your provider must be on an approved list from the government and you do not receive 24/7 care under waiver. Family will need to be willing to help.
The myth that a resident receiving rehab after hospitalization can easily leave a nursing home and then return. Sometimes families discuss with workers handling discharge, as some of our clients have done, that they would like to bring their parent home on a trial basis and ask, if it does not work, will they be readmitted. They may be told there is “no problem.”
Especially as to Medicaid certified facilities, this is not the case. Facilities have fewer Medicaid certified beds than they had a few years ago and acceptance back to a facility from home is difficult. If there is a need to return, a parent might need to wait months before being able to locate another placement.
Unless a well-thought-out plan at home or elsewhere is in place, families may be overwhelmed.
The best advice is to think things through before a move back home and consider it from many perspectives. Get advice if you need help.
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.