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1 – What options are available to my family to keep my dad in his home?
Your first step is to determine whether it is possible from a physical perspective to keep your father at home. To this end, I would suggest that you hire a geriatric care manager to do an assessment of both your father and his living accommodations. This is the person best suited to determine whether his home will allow him to age in place. Next you should determine whether you can manage his care from afar. It is easier to manage your dad’s care if you live nearby or if a family member lives with him in his home. Keep in mind the caregiving activity and management of his day-to-day care needs can be quite time-consuming. The cost of providing care in your father’s home can be significant. You need to determine whether he has long-term care insurance or if he was a veteran and eligible for the aid and attendance benefit so that you can make certain that he can afford to remain in his home. The cost of hiring a third-party that can help your father on a daily basis can range between $18-$30 per hour. Finally, you should consult with your father’s accountant or financial planner to prepare a cash flow analysis in order to develop a financial model to pay your dad’s cost of care.
2 – What is the best option to pay for my parents’ care needs in their home?
Paying for the cost of care one’s home can be significant. There are certain benefits such as the aid and attendance benefit from the Veterans Administration that can help to defray their cost of care. Also long-term care insurance in most cases contains a provision in the policy to pay for home care expenses. There are generally waiting periods before the long-term care insurance policy benefits kick in. In many cases, senior citizens are ultraconservative with their investments. It is usually is wise to team up with a financial planner who is familiar with the long-term care genre in order to develop an investment strategy that would provide a cash flow from their investments equal to 3 to 5% per year. Also investigate whether your parents have accumulated equity in their home. If so they may be able to utilize a reverse mortgage to help them to fund their cost of care. You can also check their life insurance policies to determine whether there is a large cash value that has built up within the policy. They can frequently borrow the cash value from a life insurance policy at a very reasonable interest rate. Keep in mind that when your parents pay for the cost of care they would be entitled to a medical expense deduction on their income tax return. This could obviate any income tax due to the state or federal government. In turn, it would provide them with additional cash flow in order to help to defray the cost of care.
3 – Should I consider moving my mom into my home or should we consider buying a new larger home for our two families?
In most cases, I find that it is most disruptive to a family to integrate a senior citizen into the home of the caregiver. The average caregiver is 46 years old, works 20 hours a week, and is tasked with raising a family. Living with the caregiver, can also isolate your mom if you live in a traditional single-family dwelling in the suburbs. The end result, could be a negative consequence for your mother. If you’re capable of buying a new home to accommodate both families, great care must be taken to protect both parties. If your mother were to ultimately need to be placed in a long-term care facility, then the new home could be deemed to be an eligible resource and subject to the Medicaid spend down rules. You could lose your home! If you were to have the misfortune of having a marital problem, your mother could find herself in the middle of such a squabble. Great care must be taken to protect both parties to such a transaction. Your mother’s right to live in the home where hopefully she will have separate accommodations must be protected in the event of your untimely death, divorce or other malady. It is imperative that you see a knowledgeable eldercare attorney to structure such a transaction.
4 – Can my parents pay my sister to be their caregiver?
Your parents certainly can pay your sister the fair market value of the time spent in the caregiving activity. I would strongly recommend that a written contract which I call a care management agreement be implemented in order to dictate the terms of the transaction. This is important on two fronts. First it implements an agreement which will protect your sister in the event a family member objects to your sister being compensated for the services that she renders. Under the Medicaid rules a transfer of funds pursuant to a contract at market value is a protected transfer of funds to a family member. Keep in mind that the compensation must be reasonable. I would suggest that the compensation be less than you would pay an outside agency or an assisted living facility. In this way, you can document how you arrived at your sister’s compensation level.
5 – What is a continuing care retirement community and when should my parents who are in their early 70s and in declining health consider such a facility?
A continuing care retirement community known as a [CCRC] is a facility where your family members can age in place. The facility will allow them to live independently but if either of your folks finds that their health is declining, they can matriculate to an assisted living or nursing home facility within the community. It is most important that you carefully review the documents pertaining to the CCRC to understand the rights that your folks would have in the event either the assisted living or nursing home facility was full and could not accommodate. In some cases, there are very strict rules and regulations that may negatively impact one inhabiting the facility. Things like drinking alcohol, smoking cigarettes and other activities may be banned or frowned upon by the facility. It is also important to determine what happens to the significant money deposit that is generally required to be made to enter the facility. In some cases, a portion or all of this deposit may be refunded to the family. In other situations, the funds or a portion thereof may be retained by the facility.
Related blogs: Hospice Care
6 – My father cannot continue living in his home alone. His home is a mess, he has no food in the refrigerator and frequently loses things including his mail. He refuses to listen to us his children. How do I convince him to move to a safer environment?
It is very difficult for you as a child to intervene with your father and compel him to leave his home. Keep in mind that this may be his last vestiges of his independence and memories of better days. I generally suggest that you hire a social worker or geriatric care specialist to deal with your father on an independent third-party basis. Sometimes a family physician, accountant, attorney or friend can intervene in a meaningful way in order to convince your father that a move is in his best interest. In a worst-case scenario, you may have to wait until your father develops a problem with his health in order for a discharge planner or a treating physician at the hospital to forbid him to return to his home.
7 – My dad is 78 years old and is terminally ill. I’ve heard about both palliative and hospice care. Are they both the same? Which is the best alternative in this case?
Both of these terms have a different meaning. Palliative care is specialized medical care for people with a serious illness. It focuses on providing relief from the symptoms and stress of that illness. The goal is to improve for both the patient and the family the quality of life of the person who is in need of care. Hospice care connotes that a person is terminally ill and in their last six months of life. The medical community provides the person in need of hospice care with comfort care. They also will interact with the family to prepare them for the death of their loved one. Social Security benefits are available to people in need of hospice care. Keep in mind that many of the medications that would be available to combat the illness that the person is facing will no longer be administered when one is placed in hospice.
Related blogs: Hospice Care
8 – Will Medicare cover the cost of my father’s care in a nursing home?
Medicare can cover up to 20 days of your father’s long-term care in a skilled nursing home facility. From day 20 to day 100, Medicare will cover a portion of your father’s skilled long-term care needs. The balance of his cost of care during the remaining 80 day period must be covered by your father’s Medigap insurance provided your father is still in need of skilled care. Without a Medigap insurance policy or in the event that your father is no longer in need of skilled care then he will become a private pay patient.
Related blogs: Medicaid Annuity
9 – My father is suffering from memory loss. He served in the Korean War and was stationed in Japan. Is he eligible for any long-term care benefits?
Your father is eligible for a benefit from the Veterans Administration known as aid and attendance. He need only have served in the military during wartime even if he was never deployed to a war zone. These rules changed after the Vietnam War. Keep in mind that this benefit which can exceed $1800 per month is means tested. It is wise to consult with an eldercare attorney who is familiar with the veterans benefits that are available to seniors who are in need of care. This benefit is available for home care, assisted living, and or nursing home care.
Related blogs: Aid And Attendance VA Benefit
10 – My mom owns her own home. She wants to age in place. I’ve heard of reverse mortgages that work in this situation. Is this a viable alternative so that I can keep my mom and her residence?
A reverse mortgage is a good option for a senior citizen over the age of 62 who has built equity in their home. In most cases, it works well for those individuals that have few investments and little cash flow or income in retirement. A reverse mortgage will permit your mom to tap up to 60% of the equity in her home as needed over a period of time determined by the borrower. Remember that once the senior citizen ceases to live in the home or passes away that the lender will compel the family to sell the home within a reasonable timeframe as determined by mortgage agreement. From the proceeds of the sale the lender will recoup the amount of the loan principal plus the accrued interest accrued during the term of the loan. Under no circumstances can they compel the family to make any payments in excess of the amount recovered when the home is sold even if there is a shortfall.
Related blogs: Reverse Mortgage
11 - The state in which I live allows me to sign a do not resuscitate form. Is it a good idea for someone that is in good health yet has attained the age of 68 years to sign this form?
I believe that it makes more sense for someone in your age bracket and in good health to sign what is known as an advanced health care directive. This document gives your family control of life-and-death decisions. A do not resuscitate form works well when someone is in a long-term care facility or an end stage condition. The problem is that you are taking the control of the life-and-death situation away from your family and placing it in the hands of the emergency medical team or the physicians in charge. This may be the best strategy when dealing with an end-of-life situation but not for a healthy individual no matter what their age.
12 - My folks are becoming forgetful. Are there any special things that I should look for in order to determine whether they have Alzheimer’s disease?
Keep in mind that Alzheimer’s disease is a specific illness. Whereas dementia is memory loss caused by any number of health-related problems. Some of the warning signs that you may begin to focus on include confusion and problem solving inability. They may forget where they are to be at a specific time or unable to locate the proper place for a meeting or an appointment. You will find that people suffering from memory loss will often misplace the mail or their keys or other items. They may suffer from poor judgment and have mood swings or personality changes that are noticeable by family members and friends. Many times, you will find that they will shy away from interacting with family and friends and cease engaging in social activities. You should watch them carefully when together for family events in order to determine whether they are having difficulty completing familiar tasks. If their memory changes are disrupting their day-to-day activities or they are having problems at work or that her out of the ordinary, then you should integrate a specialist who can evaluate them and determine whether they are in fact suffering from either dementia or Alzheimer’s disease.
13 - I’ve been told that my aunt is in need of hospice care. Who pays for the cost of this end-of-life care?
Hospice care is covered by Medicare part a. The designation that your aunt is in need of this type of care it connotes that she has less than six months to live. If this diagnosis is the accepted by the family, then she will be rendered comfort care for the remainder of her life. Hospice can either exist in a facility or in your aunt’s home. Counseling is also available to family members in order to coach them through this end-of-life process. Many of these costs of care for not only your aunt but your family as well.
Related blogs: Hospice Care
14 – I’m a 43-year-old daughter who is providing care for my mom while taking care of my own children and working part-time, the pressure and stress is getting to me what can I do to relieve this burden?
The first question that I would ask is whether you have other family members who could help you with the caregiving activity. Next you should determine what type of care you are providing for your mother. It may be something that could be handled by a home healthcare agency on a part-time basis. Many of these agencies will provide a person for at least a four hour period a couple times a week. Finding a person to help your mother with her housekeeping chores is another option. There are organizations like Meals on Wheels and Internet businesses that can provide your mother with some of her meals. One of the quandaries that you may have involves transporting your mother to the doctor or other appointments. With the advent of lyft and uber, you can now arrange with those organizations to transport your mother to her various appointments. Finally, there is an option known as respite care where your mother could be placed in a long-term care facility for a short period of time so that you could take a family vacation or rest from the caregiving activity.