Elder Care - Planning to Grow Old (PDF)

It is a good news/bad news joke. The good news is that people are living longer. The bad news is that people are living longer — and when they get “too” old they are not able to live independently. In 2003 the average cost of assisted-living facilities was $2,400 a month and a semi-private room in a nursing home was about $4,800 a month. Another statistic from a recent study revealed that 24% of the care-givers to an elderly or disabled relative lived with the person to whom they were providing care.

A study done in 2004 showed that the average cost of assisted living facilities was from $50 to $90 per day or $18,000 to $33,000 per year; home health care averages $52 per visit, or $19,000 for daily visits for a year; and skilled nursing care (giving medications, administering oxygen, etc.) averages $94 per visit, or $24,440 per year.

In the case of a physically infirm relative isn’t it better for family members to assist that person in living as normal life as possible? Once upon a time it was not all that unusual for grandparents, parents and children to live in the same household. As more people live into their 80's and 90's we may see many families with four generations alive at the same time with two of those generations in retirement. I am an optimist and believe that they will combine resources and help each other out.

For families who are not able to do it all by themselves, an entire industry called “nonmedical home-care” is available. A “home health aide” can assist on daily activities such as dressing, eating and personal hygiene at a cost of $12 to $22 per hour.

There are also adult day-care programs to provide what the name suggests. You can also consult the National Adult Day Services Association at www.nadsa.org to learn more about these community-based group programs that meet the needs of functionally and/or cognitively impaired adults. They provide a variety of health, social, and other related support services in a protective setting during business hours five days a week.

If people have a complicated situation with no obvious solution, consulting an expert could make life a lot easier. A “geriatric care manager” may be just the person to talk to. “GCM” services can be provided by a social worker, counselor, nurse, or gerontologist who specializes in assisting older people and their families. Besides the obvious role of counseling and support to the family that person can identify problems and provide solutions based on community resources.

An expert is more likely to know local resources and can assist in referrals to geriatric specialists in different disciplines. If living with the family is not feasible, a GCM can assist with moving an older person to or from a retirement complex, assisted care home, or nursing home. As one might expect these experts have started an association and a Web site, www.caremanager.org. You also can visit www.eldercare.gov to identify senior services in your community. The “locator service” is also available by phone at (800) 677-1116 on Monday to Friday from 9:00 AM to 8:00 PM.

By now you may be wondering when I will bring up the subject of AMedicaid planning” to cover the cost of nursing home care. A while back some elderly people thought it was smart to give away many or most of their financial assets to their children with the idea that they would increase their chances of qualifying for Medicaid payment of nursing home costs. It is not that simple and probably never was.

First, Medicaid is a welfare program for the poor. There are very low limits on how much a single person can have in assets and qualify for Medicaid. How low? Try less than $5,000. It is different for a married couple because a “community spouse” is not required to be totally impoverished so that the infirm spouse can qualify for assistance.

The numbers can change from year to year, so don’t take this discussion as authoritative on the current situation. The last time I checked, a married couple must have less than $94,760 of assets which are not exempt from the eligibility calculation. Exempt assets include: a home, rental real estate, vehicles, small life insurance policies, personal effects, burial contracts and plots and loans. There are also income limits for Medicaid eligibility which are too complicated to discuss here.

I could write an entire article about Medicaid eligibility, and still take the risk that it would be out-of-date as soon as I posted it to the Web site. The best approach is to consult with an estate planning attorney who is familiar with the law before making significant gifts related to qualifying for Medicaid. There are attorneys who spend most of their time navigating through all of the Medicaid rules. Estate planning attorneys who do not practice in that area know those who do and should be able to give you a referral.

Long term care insurance, a subject I couldn’t get to in this column may be a better alternative. My opinion is that any plan that involves depending upon the government is not a desirable solution.

We all want to grow old gracefully. For some of that we have to plan for the worst and hope for the best.

Patrick J. Gibbs practices law in Roswell, GA with a concentration on Wills, Trusts and Estates. This article is intended to be educational. Legal advice should be obtained as to individual needs before taking any action.

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