Thursday, January 22, 2015

Using Medicaid to Pay for Assisted Living

We received a call recently from a family looking to help their mother move into assisted living.
Photo by Abbeyfield Kent
Their mother was increasingly unable to care for herself in the large house where she lived alone. Her income was well below the 300% of federal poverty level set by the Social Security Administration and, unfortunately, she had little savings. They wanted to know how they could use Medicaid to pay for the cost of assisted living care. This family’s inquiry was very common, so we wanted to share the answer, in a general way, as a blog post.

Medicaid’s Long Term Benefits


The states and the Center for Medicaid Services (CMS) have been responding to popular demand for this form of long term care and, over the last decade, we have seen a significant improvement in the program rules and waivers with regards to their assisted living benefits.

The long term care benefits from Medicaid generally consist of nursing home care, not assisted living. (For more about how Medicaid is structured see this simple explanation.) While nursing homes provide a more comprehensive and sophisticated level of care, many people who are well enough prefer the independence and higher activity levels of assisted living communities. When someone who is Medicaid qualified, medically and financially, and yet prefers to live in assisted living instead of a nursing home, they can turn to the states’ Medicaid Waivers.

State Programs Vary


While there’s a federal administration for Medicaid oversight and regulations, the states are left to implement their own versions of the low income health insurance program. In our research, we found that 44 states now offer some help for individuals to pay at least some of their assisted living costs via Medicaid programs and waivers.

Often these state Medicaid programs use different names and ways to refer to their assisted living benefits. Sometimes these programs will be called care homes, supported living communities or adult foster care, among other names.

And it is not just the names that differ—the benefits do as well. Sometimes, the state programs will reimburse only for the actual care and skilled nursing services provided by the communities. Often, the cost of the room and food is excluded from being paid by the states, but at least a few states have waivers that include the full cost of the assisted living as long as it is at one of their approved facilities.

In order to learn more about the particular benefits available in your state’s Medicaid program and its associated waivers, we refer you to our partner’s website for a “State-by-State Guide to Medicaid’s Assisted Living Benefits.”

Affordable Alternatives


While Medicaid is one of the most well known and largest programs for long term care benefits in the US, it is still not designed to address the growing demand for receiving care in assisted living. It might not be the best source of funding for your family. Because Medicaid is often restricted to only paying for the care services, the rates paid out might not be sufficient to cover all of an elder’s expenses.

It might be best to start with an assisted living community search to find the most affordable community for your family. Assisted living rates will vary widely, even within the same city. A free search service could help families locate communities that fit their budget.

Tuesday, January 13, 2015

How to Negotiate With Assisted Living Communities for Better Rates

Singingly Happy with Your Assisted Living Rate
Photo by Abbeyfield Kent
If I were to tell you how I negotiated on the price for the purchase of a used car, you would not be surprise. In fact, you might think me a fool if I did not at least try to negotiate the price. Yet, the same thinking does not arise when we purchase long term care for an elderly loved one. A wide range of rates that residents pay for the same level of care in the very same assisted living communities strongly suggest that the prices are more flexible and negotiable than they at first seem. Indeed, negotiating may help families save as much as $300 - $500 per month ($3600 - $6000 per year). In this post, we discuss how to tactfully and skillfully negotiate for a better rate with the assisted living community of your choice to make sure that the long term care your loved one needs is affordable.

Negotiate Without Compromising Relationships

Many people are embarrassed or uncomfortable negotiating for long term care. This might arise because it is the first time that many are in fact considering purchasing this type of service and are feeling unsure of the proper etiquette. However, negotiating is not uncommon.

Because a provider will never accept a price that is not in their interest, one should not be concerned about damaging relationships. By following these insider tips, you will be sure to get what your love one needs while also being fair and direct with the community sales representative.

Know What You Want


Besides the rate that your loved one can afford, there are many other aspects of assisted living that might be important and have an impact on their quality of life. Many of these features have different cost implications for the community, so might allow you more points on which to discuss the final rate.

Besides the obvious variations in the apartment size and location, many senior living facilities allow residents to share an apartment with one or two other residents. While not for everyone, some residents might appreciate the increased social interaction that a roommate brings. Assisted living communities often have multiple levels of care and each service level carries its own cost. The important point is to have a clear idea which items are negotiable and which are not.

Find Several Alternatives


Negotiation experts will tell you that the strongest way to negotiate is to enter a negotiation knowing what your alternative is. If all of your negotiating fails and you cannot reach an agreement, what would be the next best thing for you? This is called the Best Alternative to Negotiated Settlement and it is a powerful tool. While you might not want to exercise your alternative, you will be in a stronger and more comfortable position just knowing that you have an alternative.

Tour multiple communities in your area. Ask for referrals and recommendations. All American communities have an Area Agency on Aging (AAA) and the volunteers and paid staff that work at the AAAs are very knowledgeable about local services and housing for seniors. Alternatively, you might ask at local community centers, community organizations, or your local church.

To add to your list of assisted living communities in your area, you can always use a free senior living search service. If you live close to a state border, be sure to include some communities on the other side of the border. Differing regulations or demographics might make them cheaper.

Consider the Community’s Needs


Remember that they community wants to maintain a full and happy community of residents. What are some of the ways that you can assist them in their goals? Can you write a review of their services online (For example, SeniorAdvisor.com is online community where many families share their experiences of assisted living communities).

The timing of your entrance might be important. Assisted living communities and their sales and marketing staff may have certain times of the month, quarter, or year when they are looking to for move-ins more urgently in order to meet their goals. This could be an important point to strengthen your position.

Rural communities that are further from population centers may be more in need of new residents. Moreover, assisted living communities that are outside of urban areas will likely have lower overhead costs that they are able to pass along to residents through lower rates. Similarly, smaller communities without large marketing budgets and staff might be more hard pressed to bring in new residents and may provide a more intimate and personal level of care.

Like hotels, assisted living residences will need to keep occupancy above a certain thresholds and new residences need to fill up. If they have many empty units, they will be more likely to negotiate on price. For example, some will offer move-in incentives such as credits that can be used to reduce future rent payments or will drop their standard move-in fee.

While assisted living companies typically do not state their occupancy rates with clients, referral services do have access to this information. By working with the referral service, you can arrange to view many residences in a short time.

Summary


Remember when viewing assisted living residences, keep in mind what your loved one needs. Consider what alternatives you have and actively develop a list of different residences that would fit your requirements. Finally, there is always much to be gained by considering what the other side needs in a negotiation. If you are clear about what you want and are able to pay while being open to other ways that you might be able to cut costs, then you will be more successful in your search for affordable long term care.

Tuesday, January 6, 2015

Why Does Assisted Living Cost More in Certain Areas?

And How to Use this Information to Lower Care Costs
Photo by Abbeyfield Kent


The monthly cost of assisted living in the US ranges from a low of $750 / month to a high of over $10,000 / month. This means some families are paying over 13 times as much for care than other families. This seems extraordinary and, in fact, it is when compared to range for home care (5 times) and nursing home care (9 times). In this post, we examine why such a dramatic variation in the cost of assisted living exists, the factors that affect assisted living costs, and how families can best use this information to their financial benefit.


Factors Affecting Assisted Living Costs

Some of the cost variance can, of course, be attributed to the non-care related amenities provided in a specific assisted living residence. Or said another way, how luxurious the residence is. However, we can effectively neutralize this factor by looking at average state data for assisted living costs. When we do so, we still see a range from $2,500 to $6,890 between the least expensive and the most expensive state. So what other factors affect monthly assisted living costs?

Level of Care - Most assisted living communities offer 3-5 different levels of care for their residents. Within the same community this can account for several thousand dollars difference in monthly expenses between the lowest and highest levels of care.

Population Density - How rural or urban the location of an assisted living residence is makes a large difference in the overall monthly cost for residents. A combination of factors contribute to this. Cities have higher rent prices and generally salaries are higher in urban areas. Both of these factors drive up expenses for the business and, therefore, drive up prices for the residents.

State Regulation - Each state has a different level of assisted living regulation. These laws may affect costs, for example, through staffing ratios, fire safety codes and other rules that incrementally increase expenses for organizations providing care. Having said that, it is difficult to isolate and quantify exactly how much state laws impact care costs.

Number of Residents - In industry speak, this is called the "bed size" of the assisted living residence. Larger residences, counter to the "economies of scale" concept, tend to have higher rates than smaller ones. This is likely due to two reasons, the amount of non-care related amenities provided in larger residences and different state regulations that apply to larger residences.

Personal Space - Within most assisted living communities, residents have options with regards to their "apartments." Private apartments, shared apartments, private rooms with shared bathrooms, studios vs. one bedrooms can all impact one's monthly expenses.

Negotiations - Another factor that surprisingly affects the monthly rate for assisted living is how effectively a family negotiates the cost. Knowing how much services cost and having options are ways that can help family negotiate better rates. Using a search service can help families find and compare communities.

How Families Can Use this Information

Knowing what factors affect the cost of assisted living can be an advantage for those families looking to reduce their aging care costs. Our organization recommends the following and provides free assistance to help families find the most affordable care.

  1. Look for assisted living communities outside of urban areas. Finding a rural or suburban residence can both decrease costs and increase the amount of personal space and common space the resident has.
  2. Elderly individuals who prefer a home-like environment should consider a smaller, adult family care style residences. These typically house 5 or fewer seniors and cost 10% - 20% less than larger communities.
  3. Search in neighboring states or communities that may have different regulations that make the cost of assisted living more affordable. Use of our Cost of Care Calculator to see costs by state and region.
  4. Consider a shared room, shared bathroom or smaller layout apartment—doing so can reduce costs by 15% - 25%.
  5. Look for brand new assisted living communities. They have a lot of rooms to fill very quickly and are more likely to negotiate discounted rates as a result.
  6. Consider using tools and technology not provided by the assisted living residence to keep the level of care low. For example, assisted living residences can charge $300 - $500 / month for medication management and assistance. Could your loved one's medication needs by met by purchasing an electronic medication management system? Such devices cost significantly less and modern systems send alerts to Smartphones if doses are missed. Read more about medication management technologies.
  7. Learn about a community's occupancy rate and use that as a negotiating tactic. Assisted living residences need about a 90% occupancy rate to be profitable. Residences with a lot of "empty beds" are much more likely to negotiate on the monthly rent. While many communities may be hesitant to tell you their occupancy rate, you might ascertain that information in subtle ways. For example, you can ask about how long the community's wait list is. If there is no wait list, one can presume the community is not at capacity. Another approach one can use when touring a community is to ask to see several types of each type of room. If the residence has 40 apartments and you are able to visit 5 different unoccupied rooms, you may be in a strong negotiating position.
  8. While it is time-consuming to shop around, it is absolutely worth your effort. The more communities you visit and the more quotes you receive the stronger the position you are in to negotiate. Be sure to let the marketing directors of the residences know that you are shopping around as well. They are more likely to give you a competitive quote if they are aware you are considering other options. A time effective way to gather information about multiple communities is to use a search service.
While it can be difficult to find the right assisted living community that meets your budget, the afford is certainly worth it as you gain the peace of mind of knowing that your loved one is well taken care of. Should you have any further suggestions for helping to find more affordable assisted living, please enter them in the comments below.

Tuesday, December 23, 2014

New Focus In Cost Saving Elder Care Technologies

One does not typically hear senior citizens and technology startups in the same sentence. However, the emerging caregiver crisis and the aging of the baby boomers spell a significant opportunity for the application of new technologies.

One measurement of this trend came out last week when the Wall Street Journey’s technology blog
Photo by Braden Kowitz
‘Digits’ reported that Google Ventures, the investment arm of the search engine giant, released their investment allocations for 2014. Google has increased their investments in healthcare startups by 566%! When one considers that the bulk of health care spending goes to pay for the care of the elderly, then one can begin to comprehend the size of the opportunity for cost savings technologies in eldercare, both for medical and long-term, non-medical care.

For a growing number of seniors today, their goal is to age in place, whether that means near their children or grandchildren or at the family home. Seniors express a desire to stay out of a nursing home or another long term care facility for as long as possible. Within the field of aging in place, a wide range of technologies exist and new ones are being developed. These products can help families stay in touch better with their elders, reduce the emotional stress of being at a distance, and decrease the care hours required.

Families will often imagine that new technologies will require that they and their elderly loved ones will require technical skills in order to be able to take advantage of these technologies. However, this concern is largely unfounded with the latest technologies as they are designed to be much easier to use for the elder and the family alike.

One can think of the types of technologies for aging in place as falling into three broad buckets. While this is certainly not comprehensive, it will help us cover the most significant cost saving technologies, since affordability is a principal subject for our blog.
  1. Safety
  2. Companionship
  3. Medication management
On the safety side, the 21st century versions of the basic emergency notification devices that emerged in the 1980s—such as the ones featured in the famous “I’ve fallen and I can’t get up” commercials—ensures that elders receive timely and appropriate assistance automatically. Today’s elder wearables can detect whether an individual has fallen and can monitor and transmit vitals to medical personnel as well as notify family through the wireless network. More information about personal safety products, the costs and the opportunities for financial assistance is on this page.

Companionship currently represents a large number of hours where paid home care workers have to be on site with the elder. Companionship is hard to automate. However, new communications technologies make interacting with elders easier and cheaper to do remotely and simultaneously. With the use of such technologies, it is hoped that far fewer seniors will suffer isolation and loneliness. With the increasing scientific correlation between social activities and maintenance of mental health, these technologies can help not just care for but also could improve the quality of life for many. Further information about companionship products and services, including the costs and financial aid is available here.

With the amount of medications that seniors often take these days, it’s an important job of the caregiver to keep track of medications and ensure that they are taken at the proper time and as directed. Mistakes can be costly, sometimes resulting in medical attention or hospitalization. Devices that aid the caregiver and family as to when and have to take medications carry the potential to save thousands per individual in avoided medical bills. Find out more about medication management features, pricing and assistance on our website.

With the amount of medications that seniors often take these days, it’s an important job of the caregiver to keep track of medications and ensure that they are taken at the proper time and as directed. Mistakes can be costly, sometimes resulting in medical attention or hospitalization. Devices that aid the caregiver and family as to when and how to take medications carry the potential to save thousands per individual in avoided medical bills. Find out more about medication management features, pricing and assistance on our website.

While Medicare does not pay for the cost of these helpful elder technologies, Medicaid’s Home and Community Based Service Waivers may in most states. Veterans have their own similar version of the Medicaid Waivers program. Find out more information about the assistance programs to help with the costs of personal safety monitoring, medication management and companion care services.

Tuesday, December 16, 2014

How One Technology Startup is Driving Improvements in Outcomes for Dementia Patients

Imagine a little dog appearing on the screen of a small tablet computer talking to an elderly lady about her grandchildren. Sounds like some sort of science fiction movie? Well, in fact, it is a new elder care remote assistance service offered by tech startup GeriJoy, which offers a team of expertly-trained, 24x7 caregivers via a special tablet app, all for about the cost of a Starbucks coffee every day.

All this month, we are looking at how technologies and clever innovations are changing elder care. In this post, we spotlight one particular technology that has a huge potential impact on the way that elder care is currently performed.

GeriJoy is the result of an insight that Victor Wang, a MIT grad, had while considering the condition of his aging grandmother, who lived alone back in his birth country of Taiwan. Her children and grandchildren lived far away. Wang could see the effects of the social isolation on her mood and overall mental health. Eventually, Wang’s mother left her job to return home to Taiwan to be with his grandmother, even though she could still care for herself at that point.

Wang decided to apply his graduate studies in human-machine interaction and 3D rendering to build a solution. He saw an opportunity to create a new type of business with a social purpose. Wang’s vision included addressing the coming crisis in elder care due the shortage of trained caregivers. Currently, 5 million Americans have Alzheimer’s, requiring 16 million people to care for them.

Dementia is stressful for both caregiver and elder. Life’s little changes can be a difficult and confusing moment for a senior who is facing short term memory challenges. Even the end of a shift for one home caregiver can confuse the elder who might not be able to understand.

Meanwhile, on January 1, 2015, the US Labor Department will change the worker protection rules requiring the home care industry to pay minimum wage and overtime when a caregiver’s hours extend beyond 40 in a given week. Home care agencies are responding with a higher number of shift changes rather than pay overtime. Wang’s GeriJoy works with these home care agencies helping them to smooth the increased number of caregiver shift transitions.

However, the benefits that have been shown for the elder are not limited to just better caregiver shift changes. Because GeriJoy uses real people to interact with the elders through the animated application, it avoids the current limitations associated with artificial intelligence. Wang knew that the solution had to offer a meaningful human connection. Only another human could do this emotionally sensitive job for seniors.

At first the idea of a virtual 3D pet on a tablet computer appeared to be an unlikely solution. However, unlikely solutions are sometimes the best. For the elder, recent research has shown the importance of pets in their lives. For various reasons, though, a real pet can be problematic in a care environment or at an elder’s home. Allergies, regular walks, and litter boxes pose challenges for an elder, while a pet cannot provide the type and quality of intellectual and emotional support that helps to stimulate a senior’s mind.

Wang was surprised at just how effective his solution turned out to be. GeriJoy offers elders an increased sense of autonomy. Elders who may refuse care from a stranger because of pride could be more open to GeriJoy’s digital presence.

Some might have concerns about the possibility of this type of technology for reducing the time we spend with seniors. However, Wang explains that GeriJoy is not able to replace the physical elements of care giving. Instead, GeriJoy offers a much needed supplement to physical interaction. Often, the GeriJoy service has helped to slow the mental decline of the elder, while helping to assist the human caregiver with hydration, food, and medication reminders for the elder.

As we look five years ahead in the elder care market, products like GeriJoy will have an increasingly important role to play. Current trends towards more elders aging in place and the average age of residents in assisted living continuing to rise, there will be an increasing need to facilitate their care. Technologies like GeriJoy are part of the coming set of solutions towards improving both the quality and reducing the cost of long term care.


For more on how technologies can help with elder care, see this page.

Friday, December 12, 2014

How Will New Federal Labor Rules Impact Cost of Elder Home Care?

Photo by Abbeyfield Kent
The unjust rule that, for nearly 40 years, has created an exemption for home care workers that prevented them from receiving the same minimum wage and overtime benefits that other workers—even those who perform the very same work at nursing homes instead of in the home—will be going away on January 1, 2015. However, the new US Department of Labor changes leave more questions than answers as to how the industry and state Medicaid programs will adjust and what will be the resulting impact on elder care prices.

To be clear, the amendments to the Fair Labor Standards Act will continue to exempt companion and live-in caregivers who are self-employed or hired directly by the family. However, home care agencies and other businesses that employ home care workers will not be allowed to use this exemption. This means that the agencies will be forced to comply with the rules while elders who hire workers directly will not.

The Department of Labor also set a new definition for what constitutes ‘companion care,’ stating that companions will spend no more than 20% of their working time on “care related tasks.” In order to enforce this rather ambiguous definition, the Department is suggesting that families establish written agreements with home care workers and that the workers maintain records of their hours worked.

The new rules will be effective on January 1, 2015, but Thomas Perez, the Secretary of Labor, announced in October that, in consideration of the burden placed on the states and industry, the Department would not enforce the rules for the first six months of the new year. After that period, the Department of Labor may choose to enforce its new rules, but that it would do so at its own discretion. Finally, the rules are set to be both fully implemented and fully enforced on January 1, 2016.

What Really Changes?


In some cases, home care agencies may have to raise the hourly wage of their home care workers to the state minimum wage where they are working. More often, though, it is expected that these agencies will have to schedule more workers to care for the same number of clients, as workers commonly exceed 40 hours per week. The agencies will try to minimize the number of hours that they have to pay over time.

As reported in the Huffington Post, the grassroots advocacy group Adapt has expressed concern about the potential that state agencies on tight budgets will simply cut back the hours of home care workers, limiting the care and mobility of seniors and the disabled.

Matt Salo, Executive Director of the National Association of Medicaid Directors, issued a statement just after the final rule was published that underscored the need for time for the State Medicaid agencies to adjust to the changes. Salo suggested that the rule could precipitate changes to the state Medicaid Home and Community Based Services, otherwise known as the Medicaid Waivers, the popular programs that pay for elders to transition to live outside of nursing homes, among many other things.

While the rule brings equal protection to workers who were excluded from basic labor protections for too long, the changes will also impact the cost of long term care for some of the nation’s poorest and most vulnerable seniors. Unfortunately, Medicaid Waivers are already overburdened and without a new allocation or adjustment in funding, longer wait times and lower service levels might result.

Friday, December 5, 2014

Future of Home Care: Technology for Aging in Place

Normally our organization does not focus on the future. The vast majority of families we help have immediate challenges with, or questions about, the financial side of aging care. They want solutions and answers that are relevant and available right now to address their pressing needs. In this post, we depart a little from a focus on the here and now and peer five years into the future. What will non-medical, home care look like? What elder care services will be available? What aging
The Honda Walking Assist Device
technologies will exist?

What Will Change in Home Elder Care?

One can think of non-medical home care that allows individuals to age-in-place as serving three distinct needs.
  1. Monitoring and Supervision: prevents self-injury, wandering and ensures medication regiments are followed.
  2. Physical Assistance: help with the activities of daily living such as transferring, mobility, eating and personal hygiene.
  3. Companionship: social interactions, conversation and observance of mood.
Technologies will provide change in all three areas but to varying degrees.

The area of monitoring and supervision will be most dramatically affected by new technology. In this area, the need for human assistance in the home will all but be eliminated. Wearable GPS devices will track location and alert responsible parties immediately when required. Web-enabled medication management system will do the same, track consumption and alert individuals when deviation has occurred. A whole new suite of personal data and actions will be monitoring and reported. These will include blood pressure, temperature, weight, movement within the home, falls, bathroom usage and even the opening and closing of cabinets, refrigerators and oven doors. As human based monitoring in the home will decrease, there will be an increased need for remote human monitoring of all the new data that is generated, as well as for immediate, non-emergency, on-call assistance.

The need for physical assistance in the home will also diminish as a result of new technology by not nearly at the pace or magnitude of monitoring. The past ten years have seen a slow but steady increase in equipment and devices that aid elderly individuals in maintaining their independence, think of walk-in tubs, stair-lifts, elevating chairs and toilet seats. The near future will see self-stabilizing utensils that enable persons with tremors to feed themselves. Driverless cars will create affordable out-of-home transportation options. Wearable stride management / walking assist devices will help the elderly with in-home mobility, short distance movements outside and decrease falls.

Paradoxically, as in-home technologies reduce the need for in-home care, they create an increased demand for companion care. Less visits at home from caregivers leads to an increasingly isolated life for the elderly living at home with limited mobility. Enter virtual companionship, this concept will play out several ways. Already we are seeing increased family communication with social media savvy seniors. Coming soon are simplified devices with persistent video channels open to family members. These programs are really just user-friendly, home versions of workplace video-conferencing software. Then there is a category of paid companionship for when family members are not available. Gerijoy, a new startup out of the Massachusetts Institute of Technology, offers virtual caregivers and companionship through tablet computers.

What Will Stay the Same?

Technology will delay the need for care. It will help the elderly stay in their homes longer. Still as physical needs become too much, as seniors can no longer help each other, as decreased cognitive ability prevents home life, the need for residential care in the form of assisted living and nursing homes will continue. Economic realities will result in increased usage of adult day care in place of full time home care and we will continue to see a relative decline in nursing home placements in favor of more cost effective assisted living.

Now to bring this article back to our area of expertise, the greatest thing that will not change and the area of aging that is most in need of innovation remains the issue of how to pay for care. Technology will reduce the care hours required, but still one must pay for the technology. Currently, the pace of new aging technology well exceeds the pace of developing innovate ways to pay for it.

Tell us what technology or innovative ways of caring for the elderly are you most excited about.













Monday, November 24, 2014

Knowing When an Aging Parent Needs Help

Peter Ciuffa and his mother Carolina make gnocchi together.
Peter Ciuffa and his mother Carolina make gnocchi together.
Thanksgiving is a happy time for many. We cook, eat, and travel to spend time together, often with our elderly parents, grandparents and other aging relatives. While the holidays are a joyful time, they can also prompt us to realize that our elders are not as able to care for themselves as much as before. If we don’t see them often, this could be an opportunity to compare how they are able to get along and whether it is still appropriate for them to continue to live independently.

Start By Assessing Activities of Daily Living


In this post, we provide a simple way to assess the amount of care that an elderly loved one might require through later life. We share this to encourage families to start a process of long term care planning. We focus on how to evaluate the non-medical care needs of an aging, elderly person. These non-medical needs are not typically covered by health insurance policies, like Medicare. Families are left to figure them out on their own, often paying out-of-packet for home modifications, home care, adult day care, or assisted living.

Elder care financial assistance programs and insurance companies frequently refer to the Activities of Daily Living as a way to assess care needs. Families can also use it as a checklist to identify needs and to estimate the amount of time required to provide care. This list of common activities covers the spectrum of tasks and actions that a person needs to do in a typical day.

Evaluate Both Senior and Living Situation


We recommend an improved and standardized version of the Activities of Daily Living Checklist from AARP and PBS.org. To use the checklist, try to imagine whether the elderly person would be able to do the activity on their own. If they require assistance, the checklist will prompt you to consider how many hours it would take on a weekly basis.

Because the holidays sometimes bring us to see our elder relatives in their home, this presents an opportunity to assess whether the house or apartment could be made safer and easier for them to continue living independently or, at least, with as little outside help as possible.

Be aware that some seniors might try to hide their care needs from family and loved ones. It is best to observe their behavior rather than just asking them.

How to Assess Care Needs


To do this activity, we recommend that you download a rewritable version of the Activities of Daily Living Checklist and save it locally to your computer. You can get one here.

Once you have done so, refer to each activity and decide whether your loved one requires assistance performing the task and if so, how many hours per week. Next, we recommend that you consider whether there are any tools, technologies, or modifications to the home that would help to reduce the need for outside care and help the elder feel more independent and less of a burden on the family.

Of course, these same tools, elder care technologies or modifications might also help reduce the number of hours of care needed. Consider whether and how many hours of care could be reduced by the aging assistance tools, technologies, or modifications. Estimate the net need for care by subtracting the labor savings from the original estimate of care hours for each of the activities.

Next Steps


There are some financial assistance programs to help with the cost of home modifications and improvements to safely age in place. However, if their need is great or the living situation is too challenging, this might also be a time to consider whether a senior living community might be the right move.

We recommend that families not delay on the important conversations about how to care for aging parents. A proactive approach will reduce stress, likely help you save money, and will improve the quality of care for your loved one.

Tuesday, November 18, 2014

Help Qualifying for Medicaid Long Term Care

Diversity of Medicaid Planning Assistance Options Can Confound Applicants

For those seeking long term care assistance from Medicaid, determining eligibility is challenging and the application process is daunting. Couple this with the fact the person completing the application paperwork is very often doing so on behalf of a loved one for whom they are concurrently providing care. This combination of challenges can make the process of obtaining Medicaid assistance almost insurmountable.

Fortunately, Medicaid planning assistance is available. Unfortunately, there is such a diversity of individuals and professionals who refer to themselves as Medicaid Planners that one more challenge exists for caregivers: determine which form of Medicaid planning assistance is right for your situation. Some planners provide services free of charge and others are fee-based. Some are public employees; others are employed by for-profit organizations. Some will refuse to provide assistance if the applicant's income or assets are too high and others will refuse if they're too low. To say it is confounding is an understatement.

It is not an exaggeration to say one needs assistance to determine the type of Medicaid planning assistance one needs. Here we provide that assistance—to direct persons seeking Medicaid planning assistance to the appropriate resource for their needs.

Getting Started

Photo by Nathan Pfau

Our organization has identified seven different categories of professionals who provide assistance helping families with the Medicaid application process. Start by considering which one of these groups best describes your financial situation:

 

Group 1


  1. Applicant's monthly income is less than $2,000 or $3,000 if married.
  2. Applicant's total financial assets, not including their home, are valued at less than $2,000

Group 2


  1. Applicant's monthly income is between $2,000 - $3,500. If married, joint income is greater than $3,000 but less than approximately $4,500.
  2. Applicant's total financial assets, not including their home, are valued between $2,000 and $50,000. If married, combined assets are valued at less than approximately $115,000.

Group 3


  1. Applicant's monthly income is greater than $3,500 or, if married, joint income is greater than $4,500.
  2. Applicant's total financial assets, not including their home, are valued at more than $50,000 or if married, combined assets are valued at less than $115,000.

Group 1

Applicants in Group 1, very likely, already meet their state's financial eligibility requirements for Medicaid long term care services. This means they will require no assistance qualifying or simply administrative assistance managing the Medicaid application paperwork. There are multiple sources from which they might gain help at no cost.

  • Area Agencies on Aging - there are a network of over 500 local area agencies on aging throughout the country. These agencies employ Case Managers / Benefits Counselors who help applicants to understand the Medicaid application process, gather the necessary documents and fill out the paperwork. Typically, each agency has responsibility for multiple counties.
  • County Medicaid Offices - Each county has an office responsible for managing Medicaid. Administrators may be available to help with the Medicaid application or they may refer you to the local area agency on aging.
  • SHIPs Counselors - These are volunteers who provide free counseling, usually over the phone, on Medicare and Medicaid benefits. They are perhaps better used to answer specific questions one might encounter while filling out the application, rather than guiding you through a Medicaid application process step by step.

 

Group 2

Applicants in Group 2 may already meet their state's Medicaid eligibility requirements, or they may qualify through a Medicaid Spend Down program or their assets and incomes may require some minor financial re-structuring in order to meet Medicaid limits. Because their status is uncertain, they may compromise their opportunity to qualify for Medicaid by seeking assistance from a state employed individual. Therefore, the prudent approach is to seek outside (non-public) assistance, even though they may have to spend money out of pocket to do so. It is worth mentioning that for most individuals the money they spend out-of-pocket on professional assistance is money they would have otherwise have been required to spend on care through a Spend Down program. There are multiple avenues of assistance available; each with pros & cons.

  • Geriatric Care Managers - Care managers are professionals hired to manage all aspects of caring for an aging loved one (except providing hands-on care). As such, most are familiar with Medicaid and the planning and application process. Care managers typically bill by the hour and could provide as much or as little assistance as is required for any applicant. Using a Care Manager for Medicaid application assistance is best suited for those families who also require care management assistance.
  • Eldercare Financial Planners - Financial planners specializing in eldercare can also be proficient in Medicaid planning. These professionals are best suited for those with broader financial planning goals which include but are not limited to qualifying for Medicaid.
  • Fee-Based Medicaid Planners - These are dedicated professionals who specialize in helping families gain approval for Medicaid long term care and nothing else. They bill a flat fee for their services and can be very efficient in their processes. These are best suited for families whose sole goal is to gain Medicaid approval.

Group 3


Applicants in Group 3 have both incomes and financial assets that are higher than Medicaid's limits. These individuals may not be able to afford their cost of care, especially on a long term basis, but they still do not qualify for Medicaid assistance. These candidates are typically hoping to prevent becoming impoverished in order to gain Medicaid benefits.

  • Elder Law Attorneys - Using a lawyer for Medicaid planning is probably the most expensive option but the expense is justified when a variety of complicated scenarios exists. For example, when the applicants are significantly over the limit and they have considerable assets they wish to protect or when a special needs trust is being set up for a family member. Another example is with married couples where only one spouse requires Medicaid and the other wishes to continue living independently.
  • Eldercare Financial Planners - Financial planners specializing in eldercare are also a good option especially when the financial planning needs extend beyond simply planning for Medicaid as is likely the case for families in Group 3 with higher net worths.
  • Commission-Based Medicaid Planners - Planners who work on commission are mentioned with a word of caution. These individuals make commissions from the sale of Medicaid compliant annuities and trusts and will usually only work with those with higher countable assets. They do not charge their clients. As such, their primary motivation is to sell financial products not to gain their client's access to Medicaid services. Their interests are not aligned with those of their clients. That said, they can still provide a valuable service but potential candidates must proactively look after their own interests.

Do you or your organization provide Medicaid planning services? Do you agree with our assessment? Have we missed any types of assistance providers? We welcome your comments.

Tuesday, November 11, 2014

Financial Planning for Later Life

Photo by Zuerichs Strassen
The Washington Post ran an article recently about how hard financial planning for later life stages can be. Even when families are relatively well prepared, the process can be complicated and the landscape ever changing. If that was not enough, some people who present themselves as elder care planners might actually be working on commission. The unintended effect is to recommend unnecessary financial products or services for families who are trying to make the best decisions for the long term care of their loved one.

While the complexity and possible conflicts of interest may be reasons that some of us do not choose to plan for the cost of care for the later years in life, this is certainly a shame because of the many benefits of planning. People who plan ahead for elder care costs and long term care costs often report feeling an increased sense of control and reduced anxiety about the future. Further, planning and professional assistance can often help a family save on care and improve the quality of life for the elder.

This post describes the range of elder care financial planning services, from simple self-serve options to the variety of specialists who help with specific cases, and everything in between. We share this with the hope that it leads you to find the most appropriate assistance to start the process with your loved one. As with all planning, it is always better to start early.

Resource Locator Tool

First, our organization maintains the Resource Locator Tool, which can be found online at payingforseniorcare.com. The free, self-service tool consists of a simple questionnaire that helps identify programs and services that are available to the elder. It searches over 400 regional, state, federal and private programs. While this can be a fast and simple first step, families will need to take the program information and make their own plan. Click here to use the Resource Locator Tool.

State Social Service Agencies

Throughout the country, there are local Area Agencies on Aging that have offices where families can come in and talk to a support person about their situation. Because of the role and familiarity with the local networks, they are great advisors on which assistance programs are available. Some are not as familiar with national, private or Veterans Administration assistance. Of. Because the popularity of these free services, there can be wait times for an appointment. Find your local agency here.

Elder Care Resource Planners

A step up from free services would be to work with an Elder Care Resource Planner. They help elders and their families to identify all options and build a plan to fit the elder’s evolving needs for care. Their approach is comprehensive in that they will review all of the national, state and private programs to find the highest level of support. Elder Care Resource Planners are not as expensive as other types of professionals with prices that range from $500 to $1,500 per engagement. It should be noted, though, that while the Planner develops the plan families must take responsibility for the implementation. Learn more about Elder Care Resource Planners.

Medicaid Planners

Many seniors may have to rely on Medicaid at some point. The Bipartisan Policy Center reported that Medicaid pays for two-thirds of the costs of long term care in this country. A specialist Medicaid Planner can help families learn how to qualify for this program. In this area, it is often helpful to have guidance because of the complexity of the rules and the financial products that exist to help families qualify. This service can greatly improve the likelihood of an elder being accepted into a state Medicaid program. Fees range from $2,000 for a simple case to as much as $5,000. Learn more about Medicaid Planning.

Geriatric Care Managers

While Geriatric Care Managers typically oversee the care of an elder, some also assist with some of the financial aspects. Because of the depth of their knowledge of the health needs of seniors, they offer a valuable service that helps families anticipate the changing needs of the loved one. They can also be quite knowledgeable about local prices and providers. They are usually educated as nurses or social workers and may not have a financial planning background. Their services will typically be hourly and range from $50 to $200. Search for geriatric care managers.

Veterans Benefits Advisors

The Veteran’s Administration accredits advisors to help vets learn about their benefits and apply. These specialist advisors can help vets and their families save time and improve the chances that they will receive their full benefits. They are required not to charge for actually preparing an application, but they do charge for their other time helping clients. Prices range from free to about $2500. See a list of Veterans Benefits Advisors.

Financial Planners

Finally, financial planners received specialized education and accreditation as professionals to advise families on their finances, retirement, and preparing for long term care. They typically work with middle and upper income level individuals and may not have much specific knowledge of local aging programs and services for low income families. They focus on a range of financial products to preserve wealth and can be pretty expensive. They will charge either by the hour or based on the size of the client’s net wealth.

Planning for later life stages can be challenging but the benefits are clear for families. We hope that this list of the common types of resources available to help you plan will enable you get started. Please feel to let us know about your experiences or any types of planners that we missed in the comments.