When I meet with prospective clients who want to engage in estate or elder law planning, it is not uncommon to hear them forcefully tell me something along the lines of “I will never go to a nursing home” and/or hear them allude to preferring to take walk in the woods and ‘take matters into their own hands’, or something along those lines. I understand what they are saying. It should be nobody’s life goal to call a skilled nursing facility their home. Nonetheless, we don’t always have a choice in life and the truth is that with caring and compassionate skilled care, the quality of our life can greatly be enhanced, even in a nursing home. There is however, an alternative commonly referred to as “aging in place”.
Aging in place is a relatively old concept that has had new life in recent years, coinciding with the increase in the elderly population and the stigma of nursing homes. The idea is simple. Keep your loved one in their most familiar environment, their home. All while balancing the needs for social interactions, rehab/exercise, and the type of care they require on a day to day basis. After all, if a loved one has dementia, robbing them of their short-term memory, why not surround them with pictures and furnishings that make them feel comfortable. Typically, aging in place requires not only a residence that can physically accommodate a loved one (safety bars in bathrooms, larger hallways, and doorways, etc..) but also someone ready, willing, and able to provide the care. That brings us to one of the most overlooked parties in the long-term care planning equation: the caregiver.
In 2016, the New York Times addressed the life of a caregiver in an article that told the heartbreaking, but increasingly familiar story of Mark Donham, the husband and now widower of his wife, Chris. Mark’s wife had early-onset Alzheimer’s and Mark stood by his wife’s side the entire time. As the article details, Mark quit his regular job in order to take on the much harder job of being a 24-hour caregiver. Laundry, cleaning, and later toileting, feeding, and transporting were all part of his new job description.
By all accounts, Mark did everything he could until the disease took his wife. Along the way, his efforts had a negative impact on his life in more ways than just grief. The stresses of caring for his wife, whether financial, physical, or emotional, took its toll. Please know that help is out there for you and your family.
When we do our educational Estate and Medicaid Planning seminars, it is routine for attendees to hear about “Community Medicaid” for the first time. A part of the federal Medicaid program, Community Medicaid is a vehicle through which people can get skilled nursing or home health aids in their own homes. Community Medicaid can even include programs that get your loved one out of the house to get that valuable social contact. Similar to Medicaid coverage in nursing homes, Community Medicaid is a needs-based program and an applicant must be below certain resource levels in order to qualify. Unlike nursing home care however, Community Medicaid’s application does not include a 5-year lookback period, meaning that it is never too late to get help caring for your loved one at home. In addition, with proper counsel, you can also use excess income (income above the Medicaid cap) for your expenses figuratively having your cake and eating it too, i.e. getting Medicaid to pay for hours of care for your loved one while using that loved one’s excess income for either additional care or paying other expenses.
Aging in place is a wonderful idea. Taking care of your loved one through their dementia is a good and noble thing. Doing it alone however is something you should try to avoid. Look into Community Medicaid for the sake of your loved one and yourself.