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.

Tuesday, November 4, 2014

12 Most Popular Articles on Financial Options for Elder Care

Many people discover our website through search. We are very happy to be there when people need more information about financial options for caring for an elderly loved one. Over the six years that we have been providing information services for programs and support for caring for seniors, we have learned a lot about what people are looking to learn more about. Here is the list of our most popular articles:

1. Home Care Financial Assistance and Payment Options – Article

Home care is increasing in popularity and it is easy to see why this information rich article tops our list. In this article, we take a closer look at the costs that are involved in home care, define the most important terms, and explain how the major long term care programs will and will not help cover the costs of home care.

2. Financial Assistance and Funding Options for Assisted Living – Article

Assisted living is an attractive and very diverse set of services. For families who are new to elder care, this informative article will serve as an excellent primer on topic. We review the costs and financial options for paying for assisted living. A wide variety of options are discussed from creative uses of home equity to clarifying which types of services Medicare will cover.

3. Medicaid's Assisted Living Benefits: Availability and Eligibility – Article

Medicaid has expanded, state by state, towards offering more assisted living benefits for eligible seniors. In this article, we dive into the topic on how, when, and where Medicaid can be used to cover assisted living expenses. Readers, no doubt, appreciate the comprehensive table of all state Medicaid assisted living benefits.

4. Receive Payment as a Caregiver: Cash and Counseling and Other Options – Article

From its debut as a pilot program, Medicaid’s Cash and Counseling options have been extremely popular. The programs have grown significantly over the years and the appeal is not hard to see. These flexible programs are often used to help pay family caregivers. Readers likely value our factual approach and well linked articles.

5. Costs of Senior Care – Article

As the title suggests, this article introduces the reader to many of the costs, fees, and less known expenses associated with caring for an elderly loved one. Updated annually, readers learn what average costs are and how they vary by geography and other factors.

6. Medicaid and Long Term Care for the Elderly – Article

Continuing with our friendly and helpful tone, this article seeks to assist the reader with gaining a basic understanding of how Medicaid functions. We address some of the common misunderstandings, clarify the various names that the programs are called, and explain the eligibility requirements. This is an invaluable crash course on using Medicaid for long term care.

7. Medicaid's Home Care Benefits: Eligibility, Waivers & Application Information – Article

Addressing another popular topic, this article seeks to make sense out of Medicaid’s benefits for home care. While a federal program, Medicaid is implemented by the states. The policy is made quite complex by all the state variations. Readers save not just money but their time spent researching Medicaid.

8. Making and Paying for Home Modifications to Enable Aging in Place – Article

Anyone who has had to care for an elderly loved one in their home will understand how daily life can be made extremely difficult by common architectural features. Readers will learn how to receive assistance to pay for modifications to allow a senior to continue living in their home and community.

9. Medicaid Planning: When it is Necessary and Finding Assistance – Article

While our informative site provides a lot of knowledge for family caregivers looking after an elderly loved one, a professional Medicaid planner can apply their specialized knowledge to their particular senior’s situation to help the family save money. This article will help a family decide whether to work with a Medicaid planning professional.

10. How to Pay for Nursing Home Care – Article

Skilled nursing might be necessary for some seniors. In this article, we dive deeply into this topic and how to make sure that the reader gets the information that they need to provide for an elderly loved one. From Veteran’s benefits to Medicare, this article reviews all of the programs and explains how they can be used. We also included a table on home nursing daily rates in all 50 states.

11. Paying for Walk-in Tubs: Medicare's Benefits and Other Financial Help – Article

Somewhat surprisingly, we discovered that this article’s focus on one particular home modification was very popular with readers. Walk-in tubs are sometimes a key feature that allow an elderly person to continue to live in the home where they are most comfortable. Medicare can be sometimes used to help offset the costs of walk-in tubs.

12. Types of Senior Care: Definitions and Comparisons – Article

Rounding out our review of the top 12 pages on our site is another great introduction for readers new to elder care. The field has many specific terms that can confuse someone. Often these particular terms make the difference whether one is eligible or not. Readers learn essential information that helps them throughout their care giving journey.

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.