Eldercare Resource Center

How to Pay for Alzheimer's Care

2012-01-31T10:03:00.000-08:00

Caring for an individual with Alzheimer's is expensive, be it financially, emotionally or at a cost to one's free time. Being a caregiver or even simply managing others to provide care is labor intensive. Additional stress comes from taking on household responsibilities that were formally shared. How does one pay for Alzheimer's or dementia care and how is that different from paying for other forms of home care or assisted living? Read on or use our Alzheimer's Financial Assistance Locator.

There are two elements unique to Alzheimer's disease or dementia that can make caring for loved ones more challenging and therefore more expensive. Many individuals that require home care do so for physical limitations. They require physical assistance with their activities of daily living however they are generally mentally capable of caring for themselves. Individuals with Alzheimer's often have periods of confusion mixed with relatively normal periods. However those periods are unpredictable which results in a need for near constant supervision to prevent individuals from wandering or harming themselves.

The second factor that makes caring for Alzheimer's more difficult is the progressive nature of the disease. Many individuals can benefit from the development of a daily routine. However, due to the progressive nature of condition, maintaining that routine can require ever increasing amounts of attention and care and eventually abilities decline to such an extent that the development of a new routine is necessary. Again, this results in increasing care costs.

Paying for Alzheimer's care is different from other forms of care mainly due to how prevalent Alzheimer's has become; because the condition is so widespread there are additional options available to families and caregivers that are not available to those who require home care or senior living for other reasons. Many states, for example, have recognized that one way to keep Alzheimer's care costs down is to provide assistance, financial and otherwise, to family members to help them care for their loved ones at home. To that end, they have developed programs whose eligibility criteria is solely that an individual be diagnosed with Alzheimer's or related condition. This differs from other state-based care assistance programs which almost always have income and asset limitations as an eligibility requirement.

In addition, again due to the fact that today over 5 million Americans have the disease, the non-profit sector supporting Alzheimer's patients is very well established compared to non-profits and foundations that are targeted to assist less widespread conditions. There are two major, national organizations with regional chapters as well as countless local organizations. These non-profits offer reduced rate respite care services, caregiver training and many other forms of support including direct financial assistance.

We've recently added significant new content to our website regarding paying for Alzheimer's care. We suggest families take the first step of understanding Medicare's Alzheimer's care benefits. Once they have an understanding of what insurance will and will not pay for, they can search our database for programs that provide financial assistance for Alzheimer's care.

Medicaid, oh Medicaid

2012-01-08T18:22:00.000-08:00

Rarely has one program that has helped so many people in such dire situations generated so much controversy, confusion and angst as Medicaid. While it is beyond our organization's mission to propose a better system, it is within our objectives to reduce some of the confusion with regards to qualifying for Medicaid.

Even more confusing than qualifying for Medicaid is trying to understand the benefits provided by the long term care program and all its related waivers. Some of the confusion stems from the fact that the program serves many constituents under the same name; children, the poor, pregnant mothers, the disabled and the elderly all can receive benefits from Medicaid. Undoubtedly more confusion is generated because the program has different policies, waivers and procedures in each state. Our organization continues its ongoing effort to highlight those Medicaid programs which are relevant to the elderly and their families. We've published over 100 articles on Medicaid waivers and benefits.

Many families hold the outdated view of Medicaid that it only helps individuals that reside in nursing homes. While maybe accurate at one point in time, today families can receive assistance from Medicaid at home, in adult day care, assisted living, foster care homes and in nursing homes. Medicaid even helps adult children to get paid to care for their parents or other elderly relatives. This relatively new concept has grown from a pilot program called Cash and Counseling. We maintain a database of all programs nationwide that offer this option which is also referred to as consumer direction.. Read about consumer direction in Medicaid.

Paying for Durable Medical Equipment and Supplies

2011-11-25T10:21:00.000-08:00

During the holiday season, we often think about families being together in their homes. Helping our aging loved ones remain in their homes often means that purchasing special medical equipment. Funds for the purchase of durable medical equipment and supplies come from a variety of sources, including Medicare, Medicaid and other private insurance companies. The Veterans Administration and non-governmental organizations such as non-profits and foundations also provide assistance to many.

There are lesser known programs that can help as well. For example, many items of durable medical equipment can also be considered to be "assistive technology". All 50 states have Assistive Technology Programs that provide various types of assistance with the purchase, fitting and lending of assistive technology devices. There is also a nationwide network of approximately 500 Independent Living Centers that offer expertise and experience, if not financial assistance, to persons seeking to remain living in their homes instead of in skilled nursing facilities.

To minimize out-of-pocket costs, it is important to know the benefits and processes for purchasing home medical equipment using insurance and the limitations of insurance coverage. Often, an individual or their caregivers desire an item of medical equipment that provides comfort but is considered beyond what is "medically necessary". Since these items are not considered medically necessary, often insurance such as Medicare will decline to pay for the item. Knowing Medicare's upgraded durable medical equipment process will enable individuals to receive partial assistance for the purchase of these items instead of receiving an outright denial for the claim.

Finally, should it be necessary for an individual to pay out-of-pocket the full cost of an item of durable medical equipment, there are ways to save money. We explore the pros and cons and cost savings associated with purchasing used home medical equipment, renting home medical equipment and using online marketplaces for medical equipment.

One can explore all these topics and learn other ways to pay for or reduce the cost of medical equipment and caring for the elderly on our website.

Paying for Prescription Drugs: Assistance for the Elderly

2011-07-28T13:53:00.000-07:00

Even with the recent changes to Medicare’s donut hole, the cost of prescription drugs continues to be a challenge for many seniors. Prescription drug statistics tell the story well.

Percent of Americans over 60 that used at least two prescription drugs in the last month – 76%
Percent of Americans over 60 that used 5 or more prescription drugs – 37%
Percent increase in the cost of brand name drugs in the last 5 years – 41.5%
Percent increase on prescription drug spending between 1999 and 2009 – 100%
Percent of doctors visits that result in some form of drug therapy – 74%
Percent of seniors on Medicare that skip one or more of their medications due to the cost – 25%

While these statistics are alarming, there are many sources of financial assistance to help the elderly obtain the medications they require. Assistance is not limited to federal and state programs; the pharmaceutical companies also offer programs that provide medication aid to the elderly. In addition, an informed and pro-active senior or their caregiver can take steps to obtain prescriptions at a much lower cost than full retail pricing.

Many state governments have pharmaceutical assistance programs for seniors that work with Medicare. These programs typically either help pay for the senior’s Medicare Part D premiums or help to lower their prescription co-payments. Almost all major pharmaceutical companies have patient assistance programs that help lower income individuals, even those without insurance, to afford the drugs which their physicians prescribe. It may be difficult for many seniors to break the habit of using a local pharmacy. However, given the fact that so many medications for the elderly are taken on an ongoing basis, it can be significantly less expensive to purchase medications through mail order or using online pharmacies. Admittedly it may require the influence of a caregiver or adult child to help an elderly loved one make this transition.

We’ve recently added a large content section to our website to help families lower the cost of prescription drugs. One can also use our Resource Locator Tool to find programs that help pay for prescriptions.

Paying for Home Modifications for the Elderly

2011-07-11T13:29:00.000-07:00

When compared to the cost of a nursing home at around $70,000 a year, the cost of making modifications to one’s home to accommodate for aging challenges is not that expensive. Federal and state governments carry much of the load for the cost of nursing home care and they recognize that caring for the elderly at home is less expensive. They seek to avoid any unnecessary institutionalization of the elderly and providing assistance for home modifications is one strategy to achieve that goal.

Federal agencies such as USDA and HUD offer programs to assist families in making home modifications. The Veteran’s Administration also provides several grants for disabled and elderly veterans. Another source of assistance comes from non-profits and community organizations. National non-profit organizations such as the Alzheimer’s Association and MS Society have programs that help accommodate independent living for persons with those respective conditions. Also many community organizations develop or participate in building projects that provide free labor to the elderly to make home improvements, such as the installation of handrails and wheelchair ramps.

To help families find assistance to pay for home modifications, our organization has added home modification assistance resources to our database of financial resources for eldercare. One can browse through the available programs or use the locator tool to discover how to pay for home modifications.

Life Expectancy Calculators and Long Term Care

2011-06-14T08:17:00.000-07:00

Lifespan calculation tools can be useful for long term care planning in different ways. When doing retirement planning, for example, knowing how long you and your spouse might live is very useful information to have. Should one plan for 10 years or 30 years of life after retirement? The financial requirements are dramatically different. What about expected lifespan differences for men vs. women or Hispanic-Americans vs. Asian-Americans? How about if your family has a history of heart disease?

There are two types of life expectancy calculators; those that use statistical data and those that use personal data. Statistical calculators look at the average life expectancy for other individuals with similar demographics in order to project one’s lifetime. Personal life expectancy calculators input real data usually from medical diagnostic tests to make life expectancy projections.

Statistical calculators may have margins of error in years and therefore are best used in support of long term planning decisions like insurance or annuity purchases. Personal life span calculators can be accurate within a few months and are best used for shorter term life care decisions, such as whether to keep a loved one at home or in a skilled nursing or assisted living community. Another useful application for personal lifespan calculators is in support of financial decisions such as whether or not to take a reverse mortgage to pay for care.

This website offers links to a variety of different life expectancy calculators.

The Language of Long Term Care

2011-06-01T10:53:00.000-07:00

As we have worked to help find families find the financial means to pay for care, we’ve come to realize that when an individual first develops a need for long term care, they or their caregivers are rarely knowledgeable about the subject. There are many confusing phrases, definitions and acronyms that those of us that focus on the subject full-time mistakenly assume that everyone understands.

In fact, most families are blissfully unaware and thoroughly confused by long term care terminology. In our ongoing effort to demystify the subject, we have begun creating short articles that explain some of the basic language and answer frequently asked questions.

For example, we have written about what are the Activities of Daily Living and why are they important? What is the difference between Medicare and Medicaid? And we have discussed the concept of consumer direction and how it is playing a larger role especially for individuals using Medicaid.

We hope our readers will contribute their questions and ideas about what they find confusing in the long term care space.

Who Pays for Long Term Care - Common Misperceptions

2011-04-25T09:44:00.000-07:00

While developing financial plans for long term care, families often hear bits and pieces of information from their friends and families about programs and resources that can help. The topic can be confusing and there exists a lot of misinformation. We recently revised and expanded the Common Misperceptions about Who Pays for Long Term Care section of our website to help families alleviate some of this confusion.

It seems one of the areas that generates the most confusion are federal programs that provide assistance to the states. Families hear these programs are designed to help the elderly and don’t realize that they do provide assistance but only indirectly. Programs, such as Community Living Grants, provide assistance by funding states agencies that in turn, develop programs with those funds that provide services for the elderly. There are also programs such as The CLASS Act, which will help families directly but not from several more years.

Our hope is by providing information about programs that do not provide direct assistance, families can very quickly learn about those programs and not extend further effort searching the Internet for information. We hope our readers will contribute information to this blog on programs they have found confusing or misleading so that we can continue to build out this section of our website.

Veterans Directed HCBS - Cash and Counseling for Veterans

2011-04-18T09:05:00.000-07:00

Veterans now have a participant-directed care program similar to Medicaid’s Cash and Counseling Program. The Veterans Directed Home and Community Based Services program (VD-HCBS) allows veterans at risk for nursing home placement to receive care in their home instead of a skilled nursing facility. As an alternative to receiving health care services from the Veterans Administration, veterans are provided with access to a budget and empowered to select and manage their own care providers and supplies.

Similar to the Cash and Counseling program, the VD-HCBS program allows veterans to hire their own family members to provide personal care (with the exception of spouses and legal guardians). However, unlike Cash and Counseling, participants are not directly provided with cash to pay their care providers. In the Veterans Directed HCBS program, participants approve payments to their care and service providers and authorize the state to make those payments on their behalf.

The range of care services, health maintenance services and supplies that are covered by the VD-HCBS program is quite broad. In addition to care services, chore and maintenance services, home modifications, health club memberships, shopping escorts services can all be included. Also the purchase of almost any product that helps the veteran increase their level of independence is allowed. This could include home appliances that enable a disabled veteran to perform household chores they otherwise might not be able to do.

The program is not available nationwide yet, however more and more states are adding programs each year. It is expected that 33 states will have programs by the end of 2011. Learn more about the VD-HCBS, Cash and Counseling for Veterans Program.

Tax Deductions and Tax Credits for the Elderly 2010 - 2011

2011-02-22T09:46:00.000-08:00

Its tax season again and this year there are several tax credits and deductions available to the elderly and their families. Some deductions are applicable when the individual in need of care is being claimed as a dependent and others when they are filing as an individual or a married couple.

Tax Credits and Deductions for Elderly Dependents
Prior to discussing these options, it is helpful to understand when an individual can be claimed as a dependent. The single most important qualification is that the tax filer provides at least half of the dependent’s financial support. Second, the dependent must be related or have lived with the tax filer for one full year. An exception exists when family members together contribute 50% of the support. By creating a "Multiple Support Declaration", a family can allow one of contributing individuals to claim the elderly as a dependent.

A) Medical Expense Deductions
A dependent’s medical and dental expenses can be deducted if the total exceeds 7.5% of the tax filer’s adjusted gross income. Therefore, if a multiple support declaration is being used, to achieve the greatest tax benefit to the family unit on the whole, it makes sense for the family member with the lowest adjusted gross income to claim the individual in need of care. Read more on tax deductions of elderly dependents medical expenses.

B) Elderly Dependent Care Federal Tax Credit
Also known as the Child and Dependent Care Credit; this is a tax credit for expenses a family incurs paying for the home care or adult day care of a dependent so that they are able to work. Read more about the elderly dependent tax credit.

C) Elderly Dependent Care State Tax Credits
Many states have their own version of the Federal Child and Dependent Care Credit and most simply allow tax filers to deduct a percentage of their federal tax credit from their state tax returns. For example, if your Federal credit is $500 and your state’s rate is 50%, you can deduct an additional $250 from your state return. Read more about the state elderly dependent tax credits.

Tax Credits and Deductions for the Elderly Filing Their Own Taxes

A) Elderly and Disabled Tax Credit
Persons over aged 64 (or if younger if disabled) are eligible for this tax credit provided their income is below the required thresholds. For an individual the adjusted gross income limit is approximately $17,500 and the maximum amount for this credit in 2010 is $1,125. Read more about the Elderly and Disabled Tax Credit

B) Medical and Dental Expense Deductions
Medical and dental expenses can be deducted if the total exceeds 7.5% of the tax filer’s adjusted gross income. Since many elderly have lower incomes and high medical costs, quite often their expenses greatly exceed 7.5%. Read more about Medical Expense Deductions

2010-11-15T09:24:00.000-08:00

Chance that a senior citizen will enter a nursing home: 1 in 3
Chance that a patient in a U.S nursing home is sedated or physically restrained: 1 in 2
Average cost to stay in a US nursing home for one year: $76,680

It is statistics like these that provided the inspiration for the Eldercare Resource Center blog and the Eldercare Financial Resource Locator Tool. Looking at eldercare in the US today is a bit like watching a slow motion train wreck. Everyone can see things are going to get bad, yet we mostly feel powerless to stop it.

In reality, the cost of long term care in the US is very expensive. However, families empowered with information and inspired to plan ahead, can take a surprising number of steps to make the cost of care affordable.

The sister-site to this blog, PayingForSeniorCare.com, provides a database of 100’s of resources, programs and options that can help families pay for or reduce the cost of care for their loved ones. The Eldercare Resource Locator Tool enables families to search for relevant programs by entering their demographic information.

In the months ahead on this blog, we will explore issues relevant to eldercare and generate discussions on how families can best manage the cost of long term care.