Tuesday, October 28, 2014

Comparing Assisted Living Communities

I work for the American Elder Care Research Organization. Our mission is to help families afford the cost of elder care. One of the ways we do so is by helping families to find affordable care. Often times the word affordable is associated with inexpensive and inexpensive can have the negative association of poor quality. Fortunately, in the world of elder care, inexpensive does not mean poor quality, but I can understand the concern. To help families alleviate this concern we have put together a guide that assists families in evaluating the quality of care provided in assisted living residences.

Did You Know?  There is no federal oversight of the assisted living industry. Each state has different inspection schedules, licensing requirements and enforcement.

Regrettably, the federal government does not produce a definitive rating and ranking system that enables families to compare assisted living residences as is done for nursing homes. Therefore, in our guide, we recommend a two-stepped approach that combines reading resident reviews of assisted living communities with researching state assisted living records.

How to decide which is better? Photo by Abbeyfield Kent
However, this approach is easier said than done. Family or resident reviews of assisted living communities are widely available online.  However, as is the case for so many online review websites, one must be cautious and weed out the overtly glowing reviews produced by marketers and the strongly negative ones sometimes planted by competitors.  Alternatively, one can choose an online review site that does this for you by verifying its contributors.  One free option is available here.

State records on assisted living communities also have access challenges.  The best case scenario is a state that publishes its inspection reports online. Unfortunately, not all states do so. Some states publish only citations or violations. Others publish complaints. Further complicating matters is the fact that sometimes they publish unverified or uninvestigated complaints. Still other states publish nothing at all. 

Accessing state records is indeed a challenge. On our website, we have done much of the work for our visitors. One can read a state by state guide with details about what each state publishes, how to access those records and links directly to their databases to enable easier searching.

Start here.

Monday, October 20, 2014

What can I do if I have too much income or resources to qualify for Medicaid?

Financial products to help qualify for Medicaid

Medicaid, the Federal program for the care of the disabled and elderly poor, has strict eligibility requirements: the individual applying for Medicaid must have very low income and little assets. The exact numbers and rules will vary in each state. (To learn more about using Medicaid to pay for eldercare in general, see our article on it.)

In some cases, though, an individual who exceeds the income and asset limits by a relatively small amount may be able to qualify by using financial products to ‘lower’ their income by putting the excess money in an account that limits its use to only certain expenditures. This has created a market for products and services to help people who need assistance to become eligible.


Too Many Resources or Savings

If you are over the asset limits for Medicaid, you can’t just give away the excess as Medicaid examines past financial transactions for up to 60 months preceding application.  
Photo by
John Patrick Robichaud
To help meet the assets limits, Irrevocable Funeral Trusts are an option for some individuals who have less than $15,000 over the eligibility limits. It is important to note that these trusts must be irrevocable. 

Some might wonder why use an Irrevocable Funeral Trust to pay for a funeral. Beyond helping to qualify the individual in need of care for Medicaid, these products also have some other benefits. Instead of pre-paying a funeral home, there is no need to select and plan in detail for a funeral in advance. Also, an irrevocable funeral trust can include the travel expenses for family members who come to the funeral. However, despite these advantages, an irrevocable funeral trust is not for everyone. Learn more about irrevocable funeral trusts in our full article on them

Medicaid Qualifying Annuities are specially designed annuities that help couples where one spouse requires care and the other does not. In these cases, Medicaid rules would otherwise force the well spouse to spend  most of their joint assets on the long term care of the other spouse, leaving him or her with limited resources on which to live. In order to avoid this situation, Medicaid state rules allow the couple to create an annuity from the couple’s assets and name the well spouse as a beneficiary. Find out more about how a Medicaid planner can help create a qualifying annuity.


Too Much Income

Similarly, an individual can be disqualified for Medicaid due to an income that is too high. However, here again, some products have come in existence to help address the situation for certain individuals and couples. 

Qualifying Income Trusts, Qualified Income Trusts, or Miller Trusts help individuals overcome the income cap. In some of states, known as ‘Income cap states,’ there is a cap, or maximum on the amount of monthly income someone can have. While this amount will vary in each state, in 2014, $2,163 per month is the highest state income cap and, in some states, it is less. Income over the Medicaid limits is secured in a trust to ensure it’s used on the care and medical needs of the individual. 

‘Medically needy states,’ without an income cap, look at the income of the individual and require that it be spent down by needed medical and long term care expenses before qualifying the individual. Find out which Medicaid financial criteria apply in your state.

Additionally, nonprofit organizations operate Pooled Income Trusts. These jointly managed trusts have lower administrative costs by pooling together many qualifying individual trusts within the state. These are often used in the case of disabled persons, but elderly can also qualify if all transfers take place before the age of 65. Special Needs Trusts have a similar application, but are not pooled and managed by a nonprofit.


Get Help

For both income and asset qualifying products, Federal rules are complex and state rules also matter and vary widely. For example, sometimes one might encounter products known as a ‘Medicaid Qualifying Trusts,’ which are, in fact, no longer compliant for Medicaid. 

Find out more on our site and seek the services of a professional Medicaid planner and/or elder law attorney when you are ready.

Tuesday, October 14, 2014

Getting Paid for Caring for an Elderly Loved One with Medicaid

There are a variety of ways to help bridge the financial gap when caring for an elderly loved one. One of the most attractive approaches is to be paid as a family caregiver. For many families, this option offers two distinct advantages: receiving a new source of income while also ensuring the quality of care that your loved one receives.

In this post, we explain how Medicaid can provide this type of funding. If you are interested in the other, non-Medicaid based programs to get paid for care giving, please see this blog post (“Five Ways to Pay Family Members as Caregivers”).

Photo by the Abbeyfield Kent Society.


Medicaid, a federal program that is administered by the states, operates a series of programs referred to generally as ‘Cash & Counseling.’ The National Resource Center for Participant-Directed Services oversees the states’ Cash and Counseling programs. Other names include as Consumer Direction, Participant Direction and Self Directed Care. Most states have these programs under their own Medicaid waiver programs. They exist with a variety of names, such as Colorado HCBS Waiver for the Elderly, Blind, and Disabled and the New Jersey Personal Preference Program. See the full list here.

Program Description

At their most basic level, these programs provide cash to the participant and allow them the choice as to how best to spend it on their care. Participants can select their own home care agency, which may be someone from their own family. This means that the adult children and, in some cases, the spouse of the recipient could be hired as a caregiver.

When an individual is already enrolled in Medicaid or eligible, the agency will begin with a visit to the home of the senior to understand their needs. They will also contact the recipient’s caregivers and doctors. Once the agency has made a decision how much care is needed, a specific funding benefit is made based on the need and the regional cost of care. The benefit amount can change as the recipient’s needs change.

Most programs consider the situation where the care recipient needs a ‘surrogate’ to help them make care provider decisions. In these situations to avoid conflicts of interest, the care decision maker should be different from the individual who is employed as a caregiver.

Because the caregiver will actually become an employee of the senior, in some states, a third party organization might be required in order to make sure that payroll taxes are filed if those payments are above a minimum level where taxes are due.


  • The care recipient must be enrolled in a Medicaid consumer directed waiver. Sometimes Medicaid waivers are oversubscribed and individuals will be placed on a waiting list.  
  • In most states, individuals must be 65 and/or disabled. Participants with Alzheimer’s, who require nursing, or who require assistance with the activities of daily living are medically eligible.  
  • Participants must be a resident in one of the states where these programs are available. See our list of the state programs for detailed information on your state program.

Understandably, getting paid to provide the care that many family members are already providing is an attractive option for families. However, the programs can be complicated. For people who are considering applying to Medicaid for the first time, a Medicaid planning professional can help. 

Learn More

Individuals wishing to learn more about how these programs can be accessed for your situation should visit our website for the full article on the Cash and Counseling programs and to find out more the program in their state.

Monday, October 6, 2014

New Products Help with Eldercare Financial Planning

As the ‘Age Wave’ Approaches, Private Business Steps in with Eldercare Financial Products

With Baby Boomers nearing retirement age and with many of their parents already needing aging care, private businesses are creating a series of new financial products to help families pay for care and aging related products. Over the past ten years, the market has seen the emergence of a variety of products serving the aging market that can be grouped into three categories. First, there are products that help families to convert assets to pay for care. Second are the loans specifically designed to meet the needs of families facing a paying-for-care challenge and the third is the financial products that help families to meet Medicaid's ever-changing, eligibility requirements.

Asset Conversions

Many families have significant financial resources tied up as assets that, in this non-liquid state, cannot be used to pay for care. Usually, the asset is their home. Reverse mortgages have been available since the 1960s. However, it was not until the late 80s when the government stepped in with regulation and consumer protections, that reverse mortgages gained in popularity. Today, there are what can best be described as private reverse mortgages that allow homeowners to receive a portion of their homes' value in cash without the same upfront costs as a reverse mortgage.

EquityKey and Rex Agreements are two examples that allow homeowners to receive cash immediately by selling a percentage of their home's future appreciation.  This clever idea enables participants to both receive cash, while continuing to hold 100% of their home's existing value. These products are best suited for persons who wish to age in their homes and might need to make home modifications to do so. Learn more from the EquityKey article and the Rex Agreements article on our website.

NestCare is another option, while still in development, this product is a more consumer friendly version of a reverse mortgage except the home is actually being sold in one month, one percent increments.  Even after 100 months, or over 8 years—a complete sale—the homeowner maintains the right to live in their home indefinitely.

Like homes, life insurance is another "asset" that can now be used for pay for care while the policyholder is still alive.  Life settlements involve selling the death benefit of a life insurance policy for a portion of the benefit amount.  This concept, which is also referred to as viatical settlements, began in the 1980s. However, the newer financial products associated with life settlements are designed specifically to pay for care and do so in a manner that allows the policyholder to become eligible for Medicaid should the funds from their life insurance settlement become exhausted. These Medicaid life settlements are being pioneered by an organization called LifeCare Funding. The concept is looked on so favorably that the state of Texas passed a law that requires Medicaid applicants with life insurance to be informed of the option. Several other states are expected to follow suit with their own versions of the law. Learn more about converting a life insurance policy to help pay for long term care on our website.

Eldercare Loans

Loans intended specifically for eldercare became a reality several years ago.  However, the best model for them is still being fashioned given the challenges associated with lending money to someone in failing health. The current version of eldercare loans are made on a short term basis when the borrower is expecting an alternative source of funding to become available.  It is quite common for the need for eldercare to come unexpectedly and families may wish to borrow money for assisted living, for example, while waiting for a home to sell.  Another very common scenario is when one is waiting for veterans' pension benefits.  Elderly veterans and their spouses can receive several thousand dollars per month for care but the application process can take 6 - 18 months.  Once approved, the benefits are retroactive to the date of application, resulting in a lump sum payment. Eldercare loans are given knowing a lump sum payment is forthcoming and the loan can be repaid from that lump sum. Lear more about eldercare loans on our website.

Annuities and Trusts

The third category of financial product specifically intended to help families afford eldercare involves annuities and trusts that enable families to qualify for Medicaid or veteran's pensions.  Both Medicaid and veterans' pensions provide significant financial assistance for care but both programs have strict financial eligibility requirements that take into consideration both the applicant's (and their spouse's) monthly income and their financial assets.  Pooled income trusts, a financial product sometimes managed by non-profit organizations, provide a way to lower one's monthly income in order to meet Medicaid or the VA monthly income requirements. Irrevocable funeral trusts enable a way to pre-pay for one's funeral expenses while at the same time lowering one's overall assets to meet Medicaid and VA asset limits. Medicaid and VA planning annuities achieve this same purpose; they convert assets that would otherwise disqualify the applicant into income that can be used for ongoing care. Often a Medicaid planner can best advise families on how to best make use of these products. Learn more about how a Medicaid Planning works in this article on our site.

Given the already high and ever increasing cost of eldercare and the massive number of Americans expected to require care over the next 20 years, we expect to see the amount of private financial products addressing this market to continue to grow.


Have we missed any product you know of? Do you have experience with any of these products or services? Please share your comment on our Facebook page.

Monday, September 22, 2014

Many Options to Help with Aging in Place

Photo by Ben Sutherland
Many options exist to help when elders and loved ones want to age in place and are looking for financial assistance. In this blog, we summarize several of the different articles we maintain that relate to helping elders and their families pay for the expenses related to aging in place.

Home Modifications

Home modifications are the changes that one makes to their home to make it easier for them to live independently and with the most amount of safety. Support to help pay for these modifications comes from many programs and in many forms. Medicaid, the VA, several state programs and a many community organizations provide support and assistance for home modifications.

Visit the Home Modification article on the payingforseniorcare.com website for a complete review of these programs.

Cost saving technologies

A wide range of products are marketed as aging in place technology. In this article, we focus on current technology that helps to reduces costs. With personal safety monitoring technologies, family members benefit from knowing their loved one is safe. For individuals who spend significant time alone, online companions can help keep elders company without the travel costs. Medication Management technologies help seniors who take multiple medications on an ongoing basis and are challenged to remember to take which pills to take when.

Visit the Cost Saving Technologies article on payingforseniorcare.com for more complete coverage of the technology options that available in 2014 and help cut costs.

Durable medical equipment

Americans who are aging at home instead of in a skilled nursing facility increasingly need to purchase home or durable medical equipment. Durable Medical Equipment can be understood as different from Home Medical Supplies. Normally, multiple sources of payment exist for any single item of durable medical equipment. Seniors and their family caregivers should be aware of all the possible sources of funds that may be available in order to increase their possible benefit.

Visit the Durable Medical Equipment article on payingforseniorcare.com for more complete coverage of the financial options.

Walk in tubs

Bathroom injuries are common for seniors trying to steady themselves on shower doors, towel racks and other fixtures while getting in and out of the tub. Medicare does not consider walk in bathtubs ‘durable medical equipment.’ Medicare will not cover the expenses associated with a walk-in tub. Medicaid, however, does have options that are likely to assist in the procurement and installation of a walk in tub.

Learn more Medicaid Waivers and other programs that can help with buying and installing a walk-in tub on payingforseniorcare.com.

Stair lifts

Medicaid will likely reimburse for medically required stair lifts as long as they enable elders to continue living in at home and avoid a nursing home. Options exist for elderly veterans and their spouses who are not able to climb stairs for reasons unrelated to their military service. Because a stair life is a type of home modification, various state-specific programs provide financial assistance for them.

Visit the Stair Lifts article on payingforseniorcare.com for more complete coverage of the programs to help pay for them.

Home care supplies

Home care supplies are generally disposable and usage is intended for one person. Individual expenses associated with home care supplies vary greatly. When used for medical purposes, prescriptions might be obtained but are generally not required. However, insurance policies will more likely reimburse for the supplies when the elder has a prescription or a statement of medical need from an accredited medical provider.

Visit the Home Care Supplies article on payingforseniorcare.com for more complete coverage of the financial programs to help pay for them.