By David Kubikian
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”
I understand what they are saying. It should be nobody’s life goal to ever 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 called “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 hopefully feel comfortable? Typically, aging in place requires not only a home that physically can accommodate a loved one (safety bars in bathrooms, larger hallways and doorways), 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.
Recently, the New York Times addressed the life of a caregiver in an article that told the increasingly familiar, story of Mark Donham, the widower of his wife, Chris. His wife had early-onset Alzheimer’s and Mark stood by her side the entire time. He quit his job in order to do the much harder job of being a 24-hour caregiver. Donham did everything he could until the disease took his wife. The stresses of caring for his wife, whether financial, physical or emotional, took its toll.
Know that help is out there.
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 home.
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 does not have a five-year look-back period, meaning that it is never too late to get help caring for a loved one at home. In addition, with proper counsel, you can also use excess income you have for your expenses, figuratively having your cake and eating it to, 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.