Installment 7 of 10
In Our Series:
“Long Term Care Costs for the Middle Class: 10 Steps to Asset Protection through Medicaid in Illinois, for Middle Class Seniors and Boomers”
The first determination in selecting a facility is to realize whether a facility is required at all in order to deliver the long-term care that the senior needs.
Families should ask, “Can our loved one live at home with in-home care? Are there any alternatives to institutionalization, such as daycare? Private duty nursing care?” The answer to these questions is based on medical decision.
If a physician indicates that institutionalization is required, then another set of questions needs to be asked. For example can care be delivered in: Independent living? Assisted living? Supportive living? (Note: Supportive living is similar to assisted living, but supportive living can be reimbursed through Medicaid whereas assisted living cannot.) Intermediate nursing care? Skilled nursing care? When the time comes, will Medicaid still approve the case for eligibility if there was a personal care contract in place, allowing the children to receive compensation when they are providing care for their parents? Thus for many families the ultimate decision will be based on the medical recommendations of the attending physician so that the senior can be kept safe in the environment that is appropriate for them.
However, another series of questions and the ones in which our office spends a substantial amount of time addressing, are the legal and financial issues associated with obtaining governmental benefits to assist in the payment of the cost of care.
The only governmental benefit that will provide any support in long-term care in any of the above circumstances where Medicaid is available is the Medicaid program itself. Remember, Medicare does not pay for long-term care, it only pays for acute care and short-term rehab. Only Medicaid pays for long-term custodial care, and Medicaid has financial eligibility requirements, whereas Medicare does not.
In addition to public benefits questions, families need to ask a series of questions and visit facilities to select the appropriate facility, if a facility is indicated as required.
We recommend, rather than thumbing through the phonebook, that you contact a firm that is familiar with helping families select the appropriate facility. A skilled senior housing placement and eldercare firm should take into consideration the following: the needs of the senior, the geographic range in which the family would like to be able to visit, and access to governmental benefits to help defray some of the costs of long-term care. Once the short list of facilities is established, with the assistance of senior housing professionals, we recommend that families visit the facility before they make any final decisions.
Lastly and most important, we strongly urge that before families sign any kind of contract for long-term care, that it be reviewed by elder law counsel so that some of the harsh provisions that are often found in long-term care contracts, like mandatory arbitration provisions and clauses shifting liability to children and responsible parties, may be stricken.
Make sure your loved one gets the care they need. But it is the “who, how, where, what, and when” that can present stumbling blocks. Seek the appropriate counsel in getting these questions answered.