This week’s questions from Susan
My Mom, who I have Power of Attorney for, lives in Orlando. My sister and I are trying to bring her back to Pennsylvania because my stepdad died in February and she’s at home right now with a 24/7 aide. The cost is outrageous, $5,600 per month. She doesn’t have a lot of money left but we’re trying to sell her house. Mom has an HMO Medicare Advantage Plan and I’m looking for a nursing home or an assisted living facility with memory care or dementia services. But again, the costs are so high. I’m wondering if I can get her on Medicaid? We would like to find a nice place with good care so she can enjoy the rest of her life. I may be out of my element by asking your assistance regarding this matter, and if so, I’m sorry. I’m just trying to get information because I’m so overwhelmed and confused.
Answer
Assisted Living, Nursing Home, and 24 Hour Care
No need to apologize. We’re always happy to help seniors in any way we can. We get questions like this all the time. Although it’s not our area of expertise, I do have some information I can provide as well as some general advice.
I want to immediately point out how important it is to have a POA for your loved ones. Everyone 18 or older should make sure there’s at least a Medical POA appointed for them. Even a spouse or a parent can’t make medical decisions for their husband, wife, or children if they are incapacitated.
As far as the cost for Assisted Living, a Nursing Home, or round-the-clock at-home care can be extremely high. It’s important to know the differences in both quality of life, costs, and care between the three. Lynn Robb, who owns Care Patrol, a local agency dedicated to helping people find quality care for their families who find themselves in situations like Susan’s mother’s. Her services are free, and we have referred several clients to Care Patrol, including Susan actually. Ms. Robb is extremely good at her job and well versed. She has been a fantastic resource for both my agency and our clients.
Lynn has helped me understand a great deal. Assisted Living is the least expensive option and also provides the best quality of life because there are plenty of activities for residents to stay active physically, mentally, and socially. They provide studio style apartments with the option of a kitchenette. Food is served in a restaurant setting with home cooked style meals. There is usually an RN on site, and they also offer physical and occupational therapy if ordered by a doctor as well as help with activities of daily living: bathing dressing grooming, up to 2-person transfer, medication management, and incontinence care. The average cost is around $4,000 per month and they are always self-pay. Medicaid is not accepted.
Lynn is very adamant that a nursing home is not where people should want their family members to be. Those in a nursing home are generally confined to a bed and need round-the-clock medical care that’s similar to what’s provided at a hospital. Residents live in a more institutional type of environment and have a roommate and share a bathroom. Activities are limited, food tends to be hospital style, and depending on mobility they may have to eat in their room, although there is also a common space to dine. Nursing home costs an average of $10,000 per month. Once a person runs out of money, they apply for Medicaid. At home care generally costs $25 to $30 an hour, which means having someone 24/7 would cost $18,000 to $21,000 per month! Services are similar to that of Assisted Living without nursing and therapy. If nurses are needed in the home for services other than what Medicare covers, the cost could be even more expensive. This may be good for someone who wants to stay at home, however the social aspect may obviously not be available. Research shows that staying physically and socially is crucial to maintaining the health of older adults.
Medicaid Qualification
As far as qualifying for Medicaid, it isn’t easy. Before it can happen, all assets of the person who needs the help must be exhausted. In Susan’s mom’s case, that means all proceeds of the sale of her home will need to be paid to the agency or nursing home along with whatever other cash assets are available. And unless planned out well in advance, it’s tough to protect a home, cash, stocks, bonds, etc. There’s a five year “look back” period to ensure that people aren’t purposely hiding money to get Medicaid sooner. Also, it may not be possible to stay in Assisted Living once all assets are exhausted because, again, they don’t accept Medicaid. If assets ran out in less than three years, a transition to a nursing home would likely need to be made. Those who own a home, but don’t have cash assets, will be forced to sign that home over to the nursing facility or agency. At the time of death, whatever is owed will be paid first before any remaining proceeds go to the estate of the deceased. As far as questions about assets and what can be done to protect them, I highly recommend a consultation with an experienced and/or certified Elder Law attorney.
One other issue here. Susan mentioned her mom has a Medicare Advantage Plan HMO. It’s important that I mention, unlike Supplements, these plans are regional and can’t be transferred from one service area to another. Susan’s mom’s HMO is not taken in Western Pennsylvania except in an Emergency. She must change to another Advantage Plan HMO or PPO that’s available in the county where she will be living, in this case Allegheny. Lastly, neither Medicare and a Supplement or an Advantage Plan covers long term care.
Thank you!
If you have any questions or concerns regarding this column topic, or would like to make an appointment for a no-cost consultation, please feel free to give us a call – we would be happy to help. I’d like to remind everyone that I do a live call-in talk show called Medicare A to Z every 1st and 3rd Monday of the month on WMBS Uniontown, 590AM and 101.1FM, from 1 to 3 PM. You can listen in on their website, wmbs590.com.
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