Tag Archives: elder care

Affordable Housing Options for Low-Income Older Adults

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Safe housing that meets older adults’ needs is essential to healthy aging in communities. Many seniors with low, fixed incomes struggle to balance housing expenses with the costs of health care, transportation, and groceries.

Finding inexpensive, safe, and accessible housing can be challenging. However, several affordable housing options are available for older people with low incomes.

Section 202 Supportive Housing for the Elderly

The Section 202 Supportive Housing for the Elderly Program provides affordable housing and supportive services for older people with limited means. Through this program, seniors can maintain independence while receiving benefits such as transportation and assistance with activities of daily living (ADLs). The support allows them to continue living independently.

The United States Department of Housing and Urban Development (HUD) requires Section 202 facility owners to maintain the buildings and regularly inspect them to ensure the tenants have a safe environment. Rent typically comprises 30 percent of the tenant’s income.

Older adults who meet specific thresholds may enroll in Section 202 Supportive Housing for the Elderly Program.

  • The head of the household must be 62 years old or older.
  • There are also income requirements, which vary depending on location. Seniors must meet HUD’s income limits criteria. Generally, it is less than 50 percent or less of the area’s median family income.

The program has several benefits for those who qualify:

  • Low housing costs provide peace of mind and stability.
  • Units designed for older adults are more accessible, including features such as wheelchair ramps, wider doors, and bathroom grab bars.
  • Senior communities ease loneliness and foster social connections.

Housing Vouchers

Housing vouchers are another option for seniors. Local housing agencies provide housing vouchers to low-income households that help cover rent. These vouchers are available to families living below 50 percent to 80 percent of the poverty level; income thresholds vary by area and agency. Dwellings must satisfy housing quality standards, and owners must maintain the units.

While families can obtain vouchers regardless of age, elders and those with disabilities can receive an additional deduction.

Although housing vouchers can help some older adults and their families, limited availability and long waiting lists characterize housing voucher programs. Per the Center on Budget and Policy Priorities, only one in four qualifying households receive vouchers.

Home Sharing

Home-sharing programs can help older adults living alone stay in their homes while providing an affordable housing option for older adults. In addition to helping with costs, home-sharing can prevent loneliness, particularly benefiting older adults whose spouses have passed or children have moved away.

Through Senior Homeshares, older adults with homes can find housemates who are also elderly, helping to lessen the cost of living. The service pairs older adults with spare rooms in their homes with those on fixed incomes searching for safe, affordable housing.

Additional Options

Most affordable housing programs, such as Section 202 and housing vouchers, have waiting lists as demand exceeds availability. Additional options exist for older adults who need more immediate help with housing costs.

  • Older adults who own their homes can apply for a reverse mortgage, allowing them to continue living at home. Reverse mortgages draw upon existing equity in a home to supply regular payments, which can supplement retirement income. The federal government insures the Home Equity Conversion Mortgage (HECM).
  • For those with health care needs who have very low incomes and few assets, Medicaid could cover the cost of nursing home care.
  • Medicare pays for certain in-home health services for homebound older adults. Although Medicare does not cover rent or mortgage payments, in-home care covered by Medicare can lessen total expenses.
  • Individuals might consider moving in with family or friends to share living expenses and benefit from support.

For older adults struggling to afford housing costs, several options exist. The best choice depends on your unique circumstances. For assistance obtaining more affordable housing as you age, consider consulting with your attorney in your area.

Which Should I Choose? Nursing Home Care vs. Hospice Care

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End-of-life decisions are never easy. One of the most important decisions you may make regarding health care as you age could be whether you need a nursing home or hospice care.

To make the best choice for you and your family, it helps to know the difference between the nature of the care provided through a nursing home as compared with hospice.

Nursing Home Care

Nursing home facilities offer residential care for the elderly and disabled. The treatment patients receive from a nursing home differs from what is available in hospice care. Residents at nursing homes receive treatment to extend their lives. Care that you can expect from a nursing home may include custodial and some skilled care.

Custodial care includes nonmedical treatment, such as assistance with dressing, bathing, cooking, laundry, and other types of personal care. The provider does not need a medical license to give residents this type of care.

Skilled nursing care is provided by licensed medical practitioners. Nursing home residents may receive some skilled care, including wound care, physical therapy, injections, and other care that they may need to ensure their physical well-being.

Note that Medicare generally does not cover custodial care. And while Medicare Part A (hospital insurance) coverage may be available for enrollees with certain medical conditions, it is often limited to those who need short-term care in a skilled nursing facility, rather than a nursing home. (Learn more about Medicare’s limited nursing home coverage.)

If you are eligible for Medicaid, a program for individuals with limited income and assets, there are nursing homes in many states that accept Medicaid patients.

What Is Hospice Care?

Hospice care is an option for patients who do not wish to receive treatment to help improve their condition or extend their life, but want comfort care as they reach the end of their lives. Your hospice care team may include doctors, nurses, social workers, spiritual advisors, and volunteers.

A hospice care team is trained in treating end-of-life pain. Hospice care can be administered in a patient’s home or in an institutional setting. It also may provide support to family members and caretakers, including respite care.

If a patient has Medicare Part A and meets the following qualifications, they may have hospice care services, including pain-relieving medication and home aide services, covered:

  • A primary care physician, or a hospice care doctor, confirms that the patient’s condition is terminal and they will not live for more than six months.
  • The patient is willing to receive palliative care only and not care that is intended to try and improve their condition.
  • The patient signs a statement confirming that they will receive hospice care instead of any other Medicare-covered treatments related to their physical condition.

For Medicaid recipients with a terminal illness, certain states may provide help in paying for hospice.

A Note on Concurrent Care                                         

Complicating matters is the fact that Medicare will generally not cover nursing home care and hospice care, known as concurrent care, at the same time. Currently, individuals on Medicare must give up Medicare payment for care related to their terminal condition if they want to receive Medicare’s hospice benefit. As a result, many individuals facing a terminal illness may not opt for hospice support services.

Policymakers have been pushing for a benefit within Medicare that would allow patients who wish to benefit from hospice care services (for example, a hospice aide, in-home respite care, or nutritional support) to receive curative treatment (for example, chemotherapy) simultaneously.

The Centers for Medicare and Medicaid Services has spent the past several years testing various models, including one known as the Medicare Care Choices Model (MCCM). MCCM has been shown to improve the quality of patients’ end-of-life while also resulting in Medicare savings. However, this option has not yet been made permanent.

End-of-Life Dilemma: Which Should I Choose?

While considering the next steps to take in your health care plan, speak candidly with your family and health care team about your needs and how you see your future.

If you have questions about coverage options that may be available to you in a nursing home or with hospice care, you may consider speaking to an elder law attorney in your area.

Will Robotics and AI Be the Future of Elder Care?

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Adults 65 and older constitute the fasting-growing age demographic in the United States. When it comes to elder care, this expanding population is facing a scarcity in people equipped to support them as they get older.

One estimate predicts a shortage of 151,000 paid direct care workers and 3.8 unpaid family caregivers by 2030, increasing to a gap of 355,000 paid workers with 11 million unpaid family caregivers by 2040.

Technological advancements in robotics and artificial intelligence may be opening the doors to new possibilities for supporting aging people.

Innovations for Aging in Place and Beyond

Many older adults wish to stay in their homes for as long as possible. According to AARP, 77 percent of adults over 50 want to continue residing in their homes for as long as they can.

Yet aging can lead to challenges with mobility and memory, such that older individuals often need additional assistance to live independently. Innovations in robotics and artificial intelligence may have the potential to provide support on this front, allowing seniors to continue living at home as they age.

Developments in robotics and AI could also fulfill unmet needs in nursing homes and assisted living, increasing efficiency, helping caregivers complete tasks, and reducing the number of staff required.

Meanwhile, artificial intelligence technologies may be able to help older adults manage health conditions from home as well as receive more efficient care in hospital settings.

Robots Helping Out in Health Care Facilities

How might robots help seniors in their homes, nursing homes, assisted living facilities, and beyond? Here is a glimpse into some emerging products:

  • Panasonic has developed robotic exoskeletons designed to augment wearers’ abilities. This self-reliance support robot aims to help aging people perform everyday tasks, get in and out of bed, and sit on chairs or the toilet. The device could help individuals to perform physical tasks without assistance. Another portable exoskeleton, the APO, may be another type widely used one day in health care to help prevent falls in seniors.
  • The TUG robot is already assisting in hospitals by delivering medicine, meals, supplies, and tests, freeing nursing staff to focus on tasks requiring more education and expertise.
  • Social robots may prove another avenue for improving older adults’ mental health. Paro, a robotic seal, gives patients the benefits of pet therapy in health care settings and dementia wards where bringing live animals would be impractical. Similar to pet therapy, some individuals may find it easier to connect with robots than with people.

In the coming years, other kinds of socially assistive robots may become increasingly common in elder care. These types of robots engage with residents, provide entertainment and interaction, perform tasks, or help ensure safety:

  • A socially assistive robot called Stevie, designed at Trinity College Dublin in Ireland, was tested at a Washington, D.C., nursing home from 2018 to 2020. Stevie entertained residents by telling jokes, playing bingo, and leading karaoke. It also provided reminiscence therapy using stories and music and could clean the facility with ultraviolet light. Recognizing commands like “help me,” the robot also can alert staff when residents needed assistance.
  • Pepper, a humanoid robot funded by the Minnesota Department of Human Services, is similarly designed for socializing with residents. Able to recognize faces and read human emotions, Pepper is being introduced into nursing homes and other elder care facilities.
  • Aeo, a robot created by Aeolus Robotics, interacts with residents socially. In addition to taking selfies with residents, it performs various essential functions, such as disinfecting surfaces, opening doors, pressing elevator buttons, and alerting staff when a resident has fallen or needs help.

Technology at Home

Older adults who live alone and people with disabilities can already use Personal Emergency Response Systems (PERS), also known as Medical Emergency Response Systems. These lightweight, battery-powered wearable devices allow individuals to call for help at the push of a button. For an installation fee and a monthly monitoring charge, users receive a device that contains a radio transmitter and a console that connects to a telephone. An emergency response center monitors incoming calls.

Technology using artificial intelligence, motion sensors, and camera monitors can also provide more comprehensive assistance and monitoring for seniors aging in place:

  • CarePredict, a device worn on one’s dominant arm, tracks the wearer’s activity. When it detects deviations from behavioral patterns, it alerts a caregiver.
  • With Envoy at Home, caregivers can place small sensors in their loved one’s home that alert them when their loved one could be at risk, such as when they leave home, exhibit disturbed sleep, visit the restroom frequently, or display inactivity.
  • Integrating AI with smartphone usage is one more emerging area in senior care. A 2021 survey by Pew Research Center found that the majority of older adults use smartphones. Technology utilizing smartphones could make in-home health monitoring more accessible, particularly for homebound seniors who may postpone doctor visits or rely on telehealth.
  • With AliveCor, older adults can monitor and track their heart activity on their phones. AliveCor is a wireless personal electrocardiogram (EKG) placed on the back of the smartphone. Using an application, individuals can view their EKG results and can share results with their cardiologists.
  • Using the smartphone’s camera, artificial intelligence, and machine learning, Healthy.io makes medical assessments of urine by analyzing the concentration of chemical elements and chemical compounds in urine.
    Healthy.io also empowers users to take photos of their wounds for a digitalized wound assessment, which can track healing and help doctors make recommendations.
  • Luminostics is a diagnostic platform that attaches to a smartphone. It can recognize bacteria, viruses, proteins, and hormones from bodily fluids.

A Growing Market

Advances in medical technology are already helping health care providers manage, identify, and treat medical conditions in older adults.

According to Healthcare Dive, the Food and Drug Administration (FDA) authorized 91 AI- or machine-learning-enabled medical devices in 2022 alone. These include tools for radiology, cardiology, neurology, and more.

Going forward, AI may also become the norm for performing administrative tasks in clinical settings, giving health care workers more time to spend directly helping patients.

Is “Aging in Place” Right for Me?

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Most older adults want to remain in their homes and communities as they age rather than move into assisted living facilities or nursing homes.

For those who wish to maintain their independence and continue living at home as they grow older, taking certain steps to protect their physical, mental, and financial welfare is essential.

What Does It Mean to Age in Place?

The Centers for Disease Control and Prevention defines aging in place as a senior’s “ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level.” According to 2021 data from AARP, more than three-quarters of adults 50 and older say they would prefer to age in place.

Health Considerations for Older Americans Aging in Place

Older adults must consider their physical, emotional, and social well-being when deciding where to spend their later years. They may consider adding supplemental services over time to help improve their quality of life.

To ensure that you will have the support you need for safely aging in place, take the following into consideration:

Resources to Manage Chronic Diseases

Disease management is vital for anyone, especially an older person with a chronic illness. Many older people suffer from at least one chronic illness. If a senior has a chronic disease and wants to age in place, they and their caregivers should focus on:

  • Ensuring that spaces in the home are safe and easily accessible to make getting around easier;
  • Learning about proper nutrition; and
  • Increasing access to dental health services. Research has found that proper oral care can help prevent the progression of many chronic diseases.

Eating Well While Aging at Home

Proper nutrition is a vital part of caring for yourself at home. In facing potential changes to your financial situation after retirement, you may need help buying nutritious meals even after budgeting.

If you find yourself in need of meals, community resources may be available. Neighborhood senior centers, places of worship, and charities may provide a hot meal while you make new friends. If you cannot leave your home, some meal delivery services drop off food at your door for little or no cost.

Support for Mobility

Exercise and maintaining your mobility can increase overall physical and mental health even as you grow older. Seniors aging in place need to be able to move around their homes and neighborhoods safely. Aging in place is a much more realistic goal if you can walk for exercise, access transportation to medical appointments and errands, and maintain a safe environment at home, free from increased fall risks.

If you desire to age in place, consider simple changes you can make to your home to promote your safety. Examples of helpful modifications around the house include handrails, temporary ramps, no-slip bath rugs, and assistive seating.

Mental Health, Substance Abuse, and Memory Care Services

There is an increased need among older adults for mental health, substance abuse, and memory care services. An estimated 20 percent of older adults have a mental health disorder, and the total number of seniors with a mental health or memory care diagnosis is likely to increase over time.

Suggestions for addressing mental health concerns among older people include:

  • Focusing on preventative care. Seniors and their caregivers should work with their primary care physician to identify warning signs of depression, anxiety, other mood disorders, and memory care problems. Preventative care can help mitigate the progress of these disorders and improve quality of life.
  • Looking for common signs of a substance abuse problem. This is an often overlooked area of older adult mental health care. Older adults may turn to substances to deal with unresolved childhood problems or to avoid a feeling of loss of meaning and purpose. Some common signs to watch for include reduced hygiene, unexplained bruises, erratic behavior, and the smell of alcohol on their breath.

    If you are a senior’s caregiver and suspect substance abuse, you can find resources and support through the Substance Abuse and Mental Health Services Administration (SAMHSA).

The Need for Social Connection Among Aging Adults

Older adults benefit tremendously from social connections and interaction. People over 65 are likely to live alone, so creating a community outside the home is necessary. Feeling a sense of purpose is beneficial to mental and physical health. For seniors looking to create a sense of community and purpose, they may benefit from such activities as:

  • Joining an organization or social club
  • Volunteering for a cause close to their hearts
  • Learning a new hobby
  • Attending a religious institution
  • Adopting or fostering a pet
  • Using technology to stay in touch with friends and family

Wearables and Smart Monitoring Devices

Technology can help us not only remain connected to one another, but also monitor our health and that of our aging loved ones. Many devices make detailed health information readily available at our fingertips. These devices benefit seniors because they can learn more about their health and make the most of doctor’s visits by communicating effectively about their medical needs.

Examples of wearable health and smart-home monitoring devices include:

  • Smartwatches and smartphones, which can track your cardiac health, fitness activity, and sleep patterns
  • Medical alert bracelets and personal alert necklaces, which can aid in detecting falls or contacting emergency services when necessary
  • Contact sensors and smart locks, devices that can alert caregivers when their loved one living at home leaves a window, garage, or door open, or has forgotten to lock them
  • Smart plugs, which can automatically turn on and off lights, space heaters, thermostats, security cameras, and more

Money Management While Aging in Place

Money management can also be an area of concern for seniors and caretakers. Seniors want to make sure they have sufficient financial resources to remain in their homes and communities comfortably, eat well, care for their medical needs, and have fun.

Creating a budget with the help of financial counselors and geriatric care managers can benefit someone on a fixed income. There may even be volunteers in your area that offer a similar service. Being aware of how to prevent and avoid common types of scams that target the senior population is equally as important.

How Can Caregivers Help Seniors Age in Place?

Seniors often choose to age in place to remain independent and avoid becoming a burden to their family. Caregivers can support their goal by teaching them to use technology to communicate and track their health, helping them establish a budget, and setting them up with a routine that may include visiting their doctor, running errands, and making time to socialize.

There is nonmedical support that your loved one will need, too. Caregivers may opt to support their aging loved ones by pitching in with or hiring services for lawn care, cleaning, cooking, laundry, or pet care.

Is Aging in Place Right for You?

Careful planning is the best way to accomplish your goal of staying home as you age. If you are considering plans to age in place and want assistance, elder law planning help is available in your area. Find a qualified elder care attorney to learn more about your options.

Does Medicaid Cover Self-Measured Blood Pressure?

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According to the American Heart Association, high blood pressure contributes to many significant health conditions, including heart attack, heart failure, stroke, and kidney failure. In the United States, 121.5 million adults suffer from high blood pressure, also known as hypertension.

While half of these individuals have improved their conditions, others have uncontrolled blood pressure, which can harm their health. Self-monitoring one’s blood pressure can help control this condition. Depending on your state, Medicaid may cover part of the cost.

What Is Self-Measured Blood Pressure (SMBP)?

Medical care is an important part of blood pressure management. Yet, you can also help your doctor treat you by monitoring and recording your symptoms at home. This is called self-measured blood pressure (SMBP). When combined with a doctor’s support, SMBP might improve your health.

You can use a manual blood pressure cuff or an automated blood pressure device to monitor your BP. With at-home measurements, you can record your blood pressure levels over time. Your doctor can use this information to help treat you.

The Benefits of Monitoring Blood Pressure at Home

Some evidence suggests that SMBP with clinical support may be more effective than medical care alone.

  • When you measure your blood pressure at home, you can assess your condition regularly. You do not have to wait for a medical professional to evaluate your BP. If your blood pressure becomes dangerously high, you can inform your doctor and seek emergency treatment.
  • By keeping track of the fluctuations in your blood pressure at home, you can give your doctor detailed information to help with your treatment. For instance, your doctor can use the information to decide what kind of medication and dosage to prescribe.
  • Sometimes, blood pressure levels change depending on the situation. SMBP can identify forms of hypertension that present differently. At-home measurements can reveal white-coat hypertension (when a patient’s BP is high at the doctor’s office, but at a healthy level at home) and masked hypertension (when BP readings appear normal in a doctor’s office but are high in other settings, such as at home or work).

Why Might Medicaid Beneficiaries Need Coverage for SMPB?

Per Medicaid.gov, one-third of all Medicaid beneficiaries have high blood pressure. With uncontrolled hypertension disproportionally affecting low-income, nonpregnant adults on Medicaid, SMBP coverage and reimbursement through Medicaid can be beneficial for many.

Does Medicaid Cover Home Blood Pressure Monitoring?

Medicaid covers SMBP in certain states. Yet not all states have coverage. Continue reading for more information.

What Does SMBP Medicaid Coverage Include?

Depending on your state, Medicaid’s coverage for self-measured blood pressure could include the following:

  • Provider reimbursement for medical support
  • BP measurement devices for you to use at home (manual blood pressure cuffs or automated blood pressure devices)

In most states with SMBP coverage, Medicaid takes care of medical care as well as devices. Other states cover just one or the other. The American Medical Association outlines what Medicaid provides in each state.

Which States Cover Medical Support and BP Measurement Devices?

The following states provide coverage to some extent for both medical support and devices:

  • Arizona
  • Colorado
  • Delaware
  • Hawaii
  • Idaho
  • Indiana
  • Michigan
  • Nebraska
  • New Jersey
  • New Mexico
  • North Carolina
  • North Dakota
  • Ohio
  • Oregon
  • Texas
  • Virginia
  • Wisconsin
  • Wyoming

These states only cover durable medical equipment (manual blood pressure cuffs or automated blood pressure devices):

  • Alaska
  • Arkansas
  • California
  • Connecticut
  • D.C.
  • Illinois
  • Iowa
  • Kansas (only covers manual blood pressure cuff)
  • Louisiana
  • Maine
  • Maryland
  • Massachusetts
  • Minnesota
  • Mississippi
  • Missouri
  • Nevada
  • New Hampshire
  • New York
  • Utah
  • Vermont
  • Washington

The following states reimburse providers for supporting patients with SMBP. However, Medicaid does not pay for at-home devices.

  • Georgia
  • Kentucky
  • Montana
  • Rhode Island

Speak With an Attorney

If you have high blood pressure, self-measurement might help. Consult with an attorney to learn more about whether you could be eligible for Medicaid coverage in your state.

What Is Respite Care? Can It Help With Caregiver Burnout?

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It is easy to burn out when you are responsible for providing full-time care to an aging or disabled loved one. In some cases, caregiver burnout can result in resentment toward the individual they care for, despite their love for them.

The fact is, we all need a break sometimes. That is why respite care exists. If you are a caregiver who needs to take time for yourself, read more to learn about respite care.

What Does Respite Mean?

Taking respite means having a temporary period of rest. For primary caregivers, this typically refers to securing short-term care for your loved one – even several weeks or months – so that you can recharge amid the very real burdens of caregiving.

In finding respite, you also might make time to practice self-care, from going to the gym to connecting with friends. Do not forget to find ways to maintain your sense of self while you are in the midst of giving so much of your time and attention to someone else.

Caregivers Want Information About Respite Care

In a 2022 survey of caregivers, Caregiving in America found that most were unaware that respite care was available. Many caregivers need more education about their options for respite care and how to build a network of support to share the load of providing financial and emotional support to an ailing loved one.

Here are some of the study’s findings:

  • Fifty-nine percent of respondents reported that they were the primary emotional support system for a sick or impaired loved one.
  • Twenty-two percent of respondents said they worked more than 40 hours per week as the primary caregiver to a disabled family member.
  • Forty-eight percent of respondents disclosed they needed emotional support for themselves.
  • Forty-four percent of respondents shared that they wanted information about where to find respite care.

Caregivers need information about maintaining their own health while supporting a family member. It is essential to prioritize yourself when caring for an aging or disabled relative.

Preventing Caregiver Fatigue

The challenges of taking care of an ailing loved one can be extremely stressful. More than that, the strain of serving as a caregiver – often unpaid – can make a real and lasting impact on your own health if not kept in check.

Symptoms of burnout among caregivers may include the following:

  • Losing sleep and extreme fatigue
  • Feeling hopeless
  • Having a quick temper
  • Lack of interest in your favorite activities

If you or someone you know has taken on the responsibilities of caregiving, be aware of the signs of burnout and actively seek support. Respite care is among your potential options.

What Is Respite Care?

Respite care gives caretakers a chance to relax and take a break from the responsibility of providing full-time care to loved ones who are aging or disabled. Respite programs offer short-term replacement care. These providers will step in for a short period to take on the responsibility of caring for your loved one.

The types of care you can expect them to take on may include the following:

  • Bathing and dressing
  • Cooking and cleaning
  • Helping your loved one eat, drink, and take their medication
  • Getting into and out of bed
  • Assistance with the restroom
  • Spending quality time with your loved one
  • Helping with exercise and personal care

How Much Does Respite Care Services Cost?

The cost of respite care varies depending on how long you use the service. You can schedule respite care for several days, weeks, months, or longer.

Who Pays for Respite Care?

Private insurance will typically not cover respite care, unfortunately. If your loved one is covered by Medicare or Medicaid, you may be able to secure five consecutive days of respite care. Your loved one must be receiving hospice care benefits for Medicare to cover respite care.

Finding Respite Care

Several organizations provide respite care. If your family member is covered by Medicaid, you can speak to a Medicaid planner in your state to determine what programs may be available. As mentioned above, Medicare covers respite care under its hospice benefit.

If your loved one is not covered by Medicare or Medicaid, don’t worry; there are private organizations that provide this service. These organizations include:

In addition, connect with your attorney to talk through your options.

Becoming a Family Caregiver for an Ailing Loved One

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Taking on the responsibility of providing full-time care for an aging or disabled loved one can be a rewarding experience. Being a primary caregiver helps you rest assured that your loved one is receiving compassionate care from someone who will go above and beyond to ensure they are comfortable and looked after.

Despite your good intentions to create a comfortable environment for your loved one, full-time caregiving is a significant time commitment. There is also a financial reality that the caregiver must face. Fortunately, family members who want to serve as caregivers may have options to help cover the expense.

What Is a Caregiver, and What Do They Do?

Professional caregivers work intimately with seniors to meet their needs as they age. As individuals get older, their needs change and they may need more help going about their day.

Examples of the kinds of help caregivers provide include:

  • Bathing and grooming
  • Help with toileting
  • Medical appointments and medication compliance
  • Transportation
  • Companionship
  • Cooking, cleaning, and grocery shopping
  • Care for animals
  • Laundry
  • Coordinate benefit care/speak to insurance companies on the senior’s behalf, if authorized

Family Caregivers: Know the Downsides

Having a family member serve in the role of caregiver can make for a better experience for your loved one and, in some ways, give you peace of mind as well. However, there are some downsides to be aware of if you are considering becoming a family caregiver.

Your own health, both physical and emotional, can be negatively affected when taking on the burden of caring for a family member. Be sure to engage in self-care, maintain a healthy diet, and watch out for signs of stress and burnout. When you do need a break, consider looking into respite care.

If your loved one has specific medical issues that will require the attention and expertise of a professional health care provider, you may want to reassess whether you should take on the role of family caregiver.

Taking care of a loved one who is getting older or who is disabled will likely require a great deal of your time, too. You may find yourself not performing as well at work or having a longer commute as you fulfill the needs of your ailing loved one. Not to mention that your own immediate family may be missing out on valuable time with you while you are caregiving elsewhere.

In turn, this could mean you will have less time to hold down a full-time job. In fact, a 2020 AARP survey showed that about 20 percent of family caregivers reported experiencing a high level of financial stress. Nearly 30 percent of them stopped saving altogether as a result of providing care for their loved one.

In these challenging economic times, you must be able to support yourself while ensuring the best care for your aging family member.

Can Family Members Get Paid for Their Work as a Caregiver?

Fortunately, certain programs are available to help family members care for ailing relatives. You may need to do a bit of research to find the right option for your circumstances.

  • Medicaid Self-Directed Care

For individuals on Medicaid, the Medicaid Self-Directed Care Program is one option that gives them the authority to manage their services. In certain states, this program offers recipients the ability to use the resources allocated for home care to pay a family member to help them with their daily needs. The Medicaid Self-Directed Care Program lets seniors have more autonomy over their care.

Note that such programs vary by state, however, and not all states will have an option like this. Each state may also use different criteria to define who qualifies as a “family” caregiver. Find your local Area Agency on Aging to learn more about the possibilities, or call your local Medicaid agency.

Note that, generally, Medicare will not cover the costs of caregiving by a family member.

  • Veteran’s Benefits

If your loved one is a military veteran, there are special benefits available to cover their home care, including the Veteran’s Directed Home and Community Based Services program. This program gives veterans a flexible spending budget that the veteran can use to pay a family member to act as their caregiver.

  • National Family Caregiver Support Program

Note that this program does not pay caregivers directly. Rather, it helps fund several different types of services for family caregivers, from training in caregiving to respite care. Learn more about this program.

  • Long-Term Care Insurance

If you are thinking ahead to who will care for you as you age, you may consider long-term care insurance when creating an estate plan. Certain long-term care insurance policies allow the policyholder to pay family members to work as caregivers. However, that is not true for every policy. Some policies do not allow policyholders to pay family members to work as caregivers if they live in the policyholder’s home.

Before taking out this type of insurance policy, you should speak to your attorney to ensure you are properly advised.

Which Nursing Home Rating System Should You Trust?

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Choosing a nursing home for a loved one is a difficult decision and it can only be made more confusing by the various rating systems. A recent study found that using both Medicare’s Nursing Home Compare site and user reviews can help with the decision making.

The official Medicare website includes a nursing home rating system. Nursing Home Compare offers up to five-star ratings of nursing homes based on health inspections, staffing, and quality measures. However, Medicare’s rating system is far from perfect. The staff level and quality statistics ratings are based largely on self-reported data that the government does not verify. The ratings also do not take into account state fines and enforcement data or consumer complaints to state agencies. Nursing homes have learned how to game the system to improve their ratings.

While Nursing Home Compare doesn’t include consumer feedback, Yelp and other online platforms like Facebook, Google, and Caring.com allow users to review individual nursing homes. These user reviews are highly subjective, and it can be difficult to judge their legitimacy. These reviews are not usually taken seriously–for example, consumer guides to finding a nursing home do not usually suggest that consumers consult online reviews. (It should be noted, however, that Caring.com goes to great lengths to ensure the integrity of its reviews, including having senior care experts read every submission before publication.)

In order to better understand what consumers were saying about nursing homes online, researchers at the University of Southern California evaluated 264 Yelp reviews and grouped them into categories. The researchers found that consumers rate different aspects of nursing home care than does the official rating system. User reviews were more emotional and more likely to focus on staff attitudes and responsiveness rather than on the quality of health care.

The researchers concluded that user reviews can be used in conjunction with the Nursing Home Compare site to paint a fuller picture of life at the nursing home because they present complementary information. According to the study, online reviews shouldn’t be dismissed because they “directly capture the voices of residents and family members, precisely the kind of information [nursing homes] and their consumers need to hear and may want to act on, if resident-directed care is to be achieved.”

Yelp has gone a step further than other consumer review sites and has teamed up with the investigative news organization, ProPublica, to provide users with additional information. ProPublica’s Nursing Home Inspect site, allows users to compare nursing homes based on federal data. Yelp users viewing a nursing home review page see a ProPublica box that provides information on the nursing home’s deficiencies and fines.

Four Ways the Coronavirus Pandemic May Affect Long-Term Care Insurance

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The coronavirus pandemic has had a devastating impact on the elderly, particularly those in nursing homes and other long-term care facilities. This has raised questions about how the virus has influenced the costs and provision of long-term care insurance, which covers care in facilities and sometimes at home as well.

If you have a long-term care insurance policy, you may wonder how it is affected by the pandemic. If you don’t have a policy, you may wonder if the pandemic will make it more difficult to get one. An article by US News and World Report, examines issues with long-term care insurance that have arisen in the last few months, including the following:

  • Qualifying for insurance. It is already more difficult to qualify for long-term care insurance the older you get. Because older individuals are at a higher risk for coronavirus, this can affect your long-term care application as well. Some insurers have been limiting applicants’ ages or putting additional restrictions on applicants who have been in contact with the virus. If you had a positive COVID-19 test, you may have to wait for three to six months before qualifying for insurance. These policies vary by company.
  • Premiums. Insurers can’t raise rates for customers due to individual circumstances. To raise rates, insurers must obtain approval from the state and raise them for the entire group. However, if you are considered high risk due to exposure to coronavirus, you may not qualify for the best rates when you first apply for long-term care insurance.
  • Moving out of a nursing home. If you have a policy and want to move out of a nursing home, you will need to check what your policy will pay for. Some policies pay for long-term care in a variety of settings, including home care, but others are more restrictive. On the plus side, you may be able to use your policy to reserve your bed, allowing you to keep your nursing home spot.
  • Home care. If you have a policy that was paying for home care, there may also be changes. Some home care workers are charging more for work during the pandemic, which could exceed your policy coverage. Another change may be to the number of people entering your home. You may want family to provide care, rather than an outside home health care worker. Unfortunately, most long-term care policies don’t pay for family members to provide care. However, if you aren’t using the insurance to pay for care, your coverage may last longer–depending on the policy.

There are lots of uncertainties regarding long-term care, insurance, and coronavirus.

Transferring Assets to Qualify for Medicaid

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Transferring assets to qualify for Medicaid can make you ineligible for benefits for a period of time. Before making any transfers, you need to be aware of the consequences.

Congress has established a period of ineligibility for Medicaid for those who transfer assets. The so-called “look-back” period for all transfers is 60 months, which means state Medicaid officials look at transfers made within the 60 months prior to the Medicaid application.

While the look-back period determines what transfers will be penalized, the length of the penalty depends on the amount transferred. The penalty period is determined by dividing the amount transferred by the average monthly cost of nursing home care in the state. For instance, if the nursing home resident transferred $100,000 in a state where the average monthly cost of care was $5,000, the penalty period would be 20 months ($100,000/$5,000 = 20). The 20-month period will not begin until (1) the transferor has moved to a nursing home, (2) he has spent down to the asset limit for Medicaid eligibility, (3) has applied for Medicaid coverage, and (4) has been approved for coverage but for the transfer. Therefore, if an individual transfers $100,000 on April 1, 2017, moves to a nursing home on April 1, 2018 and spends down to Medicaid eligibility on April 1, 2019, that is when the 20-month penalty period will begin, and it will not end until December 1, 2020.

Transfers should be made carefully, with an understanding of all the consequences. People who make transfers must be careful not to apply for Medicaid before the five-year look-back period elapses without first consulting with an elder law attorney. This is because the penalty could ultimately extend even longer than five years, depending on the size of the transfer.

Be very, very careful before making transfers. Any transfer strategy must take into account the nursing home resident’s income and all of his or her expenses, including the cost of the nursing home. Bear in mind that if you give money to your children, it belongs to them and you should not rely on them to hold the money for your benefit. However well-intentioned they may be, your children could lose the funds due to bankruptcy, divorce, or lawsuit. Any of these occurrences would jeopardize the savings you spent a lifetime accumulating. Do not give away your savings unless you are ready for these risks.

In addition, be aware that the fact that your children are holding your funds in their names could jeopardize your grandchildren’s eligibility for financial aid in college. Transfers can also have bad tax consequences for your children. This is especially true of assets that have appreciated in value, such as real estate and stocks. If you give these to your children, they will not get the tax advantages they would get if they were to receive them through your estate. The result is that when they sell the property they will have to pay a much higher tax on capital gains than they would have if they had inherited it.

As a rule, never transfer assets for Medicaid planning unless you keep enough funds in your name to (1) pay for any care needs you may have during the resulting period of ineligibility for Medicaid and (2) feel comfortable and have sufficient resources to maintain your present lifestyle.

Remember: You do not have to save your estate for your children. The bumper sticker that reads “I’m spending my children’s inheritance” is a perfectly appropriate approach to estate and Medicaid planning.

Even though a nursing home resident may receive Medicaid while owning a home, if the resident is married he or she should transfer the home to the community spouse (assuming the nursing home resident is both willing and competent). This gives the community spouse control over the asset and allows the spouse to sell it after the nursing home spouse becomes eligible for Medicaid. In addition, the community spouse should change his or her will to bypass the nursing home spouse. Otherwise, at the community spouse’s death, the home and other assets of the community spouse will go to the nursing home spouse and have to be spent down.

Permitted transfers

While most transfers are penalized with a period of Medicaid ineligibility of up to five years, certain transfers are exempt from this penalty. Even after entering a nursing home, you may transfer any asset to the following individuals without having to wait out a period of Medicaid ineligibility:

  • Your spouse (but this may not help you become eligible since the same limit on both spouse’s assets will apply)
  • A trust for the sole benefit of your child who is blind or permanently disabled.
  • Into trust for the sole benefit of anyone under age 65 and permanently disabled.

In addition, you may transfer your home to the following individuals (as well as to those listed above):

  • A child who is under age 21
  • A child who is blind or disabled (the house does not have to be in a trust)
  • A sibling who has lived in the home during the year preceding the applicant’s institutionalization and who already holds an equity interest in the home
  • A “caretaker child,” who is defined as a child of the applicant who lived in the house for at least two years prior to the applicant’s institutionalization and who during that period provided care that allowed the applicant to avoid a nursing home stay.