Elder law is a broad term that encompasses a variety of legal topics that may affect seniors. An elder law attorney can help seniors plan for retirement, manage their financial affairs, and assist with qualification for government-assisted funding for long-term care. It is important to plan ahead when it comes to retirement and long-term care options since this is important for protecting assets.
Long-term Care and Housing Options
Some seniors will be able to remain in their own home as they age, while others will eventually need assistance with activities of daily living. Families who are trying to make decisions about long-term care should consider the suitability of a senior's current living arrangement as well as any medical conditions the senior may face.
When considering whether or not a current living situation is appropriate to meet a senior's needs, important factors must be considered. Sometimes, a senior living community is the more appropriate option.
Living Situation Factors
- Whether or not the senior lives alone or with caregivers
- Whether or not the home where the senior currently lives has one or two stories where a senior would need to climb stairs to reach a bedroom or bathroom
- Whether or not the senior wishes to remain in the home or wants a change, e.g., moving in with a relative or some other viable housing option
- The senior's ability to meet daily needs, including:
- walking without assistance,
- meeting hygiene needs on his or her own, and
- having an ability to meet his or her own nutritional needs
Senior Living Community
A senior living community may be an option for seniors who are able to meet many of their basic daily needs but who may require assistance with some tasks, like transportation and medication management. A transition to a senior living community can provide peace of mind for seniors and family members since many communities offer social activities and provide meals. A senior living community may offer an option for seniors who are unable to remain in their own homes but who do not need round-the-clock care.
This option, however, may not be feasible for seniors who need assistance with most of their daily living activities.
Seniors who need assistance with medication management, meals, and transportation may need to move into an assisted living facility. Every facility is different, so it is important to consider all available options when choosing which facility is the right one for a loved one.
Loved ones should consider the following factors when looking for an assisted living facility:
- The location and atmosphere within the facility
- Whether or not the residents currently residing there appear comfortable and happy
- Whether or not the residents would be good housemates for your loved one
- The activities available for recreation and socialization
- How well the facility is kept clean, free of odors, and maintained
- Whether or not the staff is professional and makes family members feel comfortable
- Whether or not the medical care available is appropriate for meeting your loved one's needs
- Whether or not the facility is Medicaid-eligible
Long-term Residential Care
Some seniors who require 24-hour care may need long-term residential care. Many seniors need long-term care if they have difficulty with activities, like:
- moving from a bed to a chair,
- grooming themselves,
- using the bathroom without assistance, and
- feeding themselves on their own.
An expert -- e.g., a social worker or a medical professional -- can evaluate the individual's care needs and make recommendations about whether or not long-term care is appropriate to best meet those needs.
If long-term care is recommended, many families will have questions about how they will pay for long-term care. Costs of living in a residential facility vary widely across the country, ranging from around $4,000 per month to as much as $23,000 per month in very high-cost areas. Individuals who need long-term care may be able to receive government assistance to help them pay for long-term care if they successfully apply for Medicaid. This is all the more reason why planning is imperative to ensure you have what you need when the time comes for elder care.
Medicare and Medicaid
Medicare and Medicaid are both government-assisted programs that can help individuals (who are elderly or who have limited income) afford care. Some individuals are eligible for both programs -- which can help pay for the costs of most of their care.
Medicare is the primary medical care insurance for a large number of seniors. Medicare is available to individuals who are aged 65 and older, and many older adults are automatically enrolled in Medicare when they turn 65. Medicare is run by the federal government.
Medicare does NOT cover costs for most types of long term care including Alzheimer's and dementia care. When it does pay, it is only in a very limited capacity. While Medicare is not a long term care solution, there are benefits for seniors with recoverable conditions on a short term basis.
Skilled Nursing Facilities
Medicare will pay for 100% of the cost of care up to 20 days at a skilled nursing facility and approximately 80% of the cost up to 80 more days. The care must be for recovery following an inpatient hospital stay.
Assisted Living Communities
Medicare does not cover any cost of assisted living. It will pay for most medical costs incurred while the senior is in assisted living, but will pay nothing toward custodial care or the room and board cost of assisted living.
Medicare will cover skilled nursing care given in the home for a limited time period, but not non-medical care. Care must be prescribed by a doctor and needed part-time only. The senior must be “confined” meaning they are unable to leave the home without the assistance of another person. This is formally referred to as "homebound".
Adult Day Care
Medicare does not pay for adult day care services.
Alzheimer's / Dementia Care
Unfortunately, most care associated with Alzheimer's is considered personal care and therefore not paid for by Medicare. Medical care associated with Alzheimer's is covered. For very late stage Alzheimer's patients, there is a hospice benefit that may be applicable to Medicare beneficiaries.
Medicare offers hospice coverage for terminally ill individuals whom doctors determine have less than 6 months to live. While Medicare hospice does not typically pay for room and board, it does cover medical expenses, prescription drugs, and homemaker services, which are typically not paid for by Medicare. Although in most cases, hospice care is given in-home, it's possible for one to opt for inpatient care.
Medicaid is a state-run program. Unlike Medicare, Medicaid is needs based. To qualify for Medicaid, applicants must disclose financial information and must follow strict guidelines.
Medicaid applicants cannot have over $2,000 in assets unless these assets are an exemption to the asset restrictions. If a Medicaid applicant has more than this amount in cash or other assets, it may be possible to spend down some of the assets in order to qualify for Medicaid. There is a 5-year look-back period (2.5 years in California) for Medicaid applications. Applicants will need to obtain bank records, and any gifts or asset transfers to family members, friends, or other individuals can delay the period of time before the Medicaid applicant can qualify for government assistance.
Special rules apply if a senior who needs to enter a long-term care facility has a spouse who will remain in the community. This is known as the “community spouse” exception to the Medicaid rules regarding assets. This exception recognizes the needs of a spouse who remains in the community to keep much of their property that would otherwise need to be paid to a long-term care facility.
It is important to plan ahead when considering long-term care options and qualifying for Medicaid. Sometimes families find themselves unexpectedly needing to consider long-term care options if a medical event, like a stroke or another injury, changes their loved one's ability to care for themselves at home. Having a plan in an emergency is much better than having no plan at all. We can help families in this situation with the application process. We can advise family members about exemptions to Medicaid income and asset restrictions to help families save their loved one's assets.
Contact an Experienced Elder Law Attorney
If you have questions about elder law or need assistance planning for senior life, contact attorney Nina Whitehurst at Cumberland Legacy Law, located in Crossville, Tennessee. You can use our online form to schedule a consultation or call us at (931) 250-8585.