||"My Dad just had a
stroke, and hes in the hospital. I guess I always knew this day would come, but,
here we are, and I really dont know what were going to do. He has lived on his
own for 10 years since Mom died; hes 87. He lives in a big old house in Brooklyn,
which he couldnt take care of before. But he has always done things his way. He
thinks hes going to march out of the hospital and pick up where he was before, but
the doctor tells me, at best, hell be able to walk with a walker, and I havent
even seen him get out of bed yet. I really dont know how to determine what his needs
will be, where Im going to get the help from, and is Medicare going to pay for it? I
have to get an aide that knows how to deal with my father, or hell throw them right
How Is Care Paid For?
When we ask How
is care paid for?, we are referring to the care that a person needs to stay safe
in her own home or apartment. This is commonly referred to as home care.
Of course we may also want to know how care is paid for in an assisted living facility,
rehabilitation center, or nursing home. The point is that the first place that care is
needed is usually at home. People usually dont go from being totally
independent/self-sufficient to needing to live in a facility.
Medicare is the
insurance most seniors receive at age 65 upon retirement if they have paid into Social
Security while they or their spouse were working. It is primarily a health insurance, with
minimal coverage for home health care. Many people are surprised to learn that Medicare
provides very little assistance in paying for care in ones own home. The amount of
help rarely exceeds 4 hours/5 days per week, is often less than that, and is not based
solely on need. It does not even pay for prescriptions. Many seniors then enroll in
Medicare HMOs, which entice people because the plans have coverage for prescriptions.
becomes a seniors primary health insurance when they retire. If they choose not to
join a Medicare HMO, which requires that they see doctors in that plans particular
network, then it is a good idea to pay for a supplemental insurance to cover, typically,
the 20% of doctors visits that Medicare doesnt cover (and other copays). These
plans are also known as Medigap policies, and a senior is usually in pretty good shape as
far as health insurance coverage is concerned, if they have Medicare and one of these
Medigap policies. But again, there is no home care benefit.
Long-Term Care Insurance
Long-Term Care Insurance
is a great thing to have for home care coverage, but it is costly, and if you have come to
this website, then it is most likely too late for this to be an option. One cant
obtain long term care insurance at the point that he needs care.
Then there is
Medicaid. In the five Boroughs of New York City, it is very possible, with the right
guidance, to access Medicaid and to obtain the amount of hours of home care per day that
are needed, even if 24-hour care is needed. New
York City has the most generous Medicaid home care program in the country. It is generous
for two reasons: i. There is no transfer of assets penalty for Community Medicaid.
Community Medicaid covers care in one's own home. (Although a Transfer of Assets penalty
exists for Nursing Home Medicaid, it is still possible to preserve a good portion of
assets.) ii. It is possible to obtain 24 hour care in one's own home, 7 days per week
(even two 12 hour shifts per day).
Consultation with an
elder law attorney is highly recommended for Medicaid planning purposes. I can refer you
to a highly qualified elder law attorney, who will ensure that the proper financial
planning has been done. Then, I handle the filing of the Medicaid/Home care application
Clients may be able to
keep home care aides whom theyve become fond of and still have Medicaid pay. This
would require the following: that the aide can document legal immigration status, that she
is willing to be paid by check and have taxes taken out of her pay by a Medicaid agency,
and that she passes a physical. I can also help find home care aides who start out
privately paid and then remain with the client once Medicaid starts paying, so that the
care recipient does not have to get used to a new person or persons.
It is possible to obtain individual home health aide
services paid by Medicaid while living at an assisted living facility, as long as the
family pays the rent, which in New York City is in the $3000 to $4000/month range. Often
this can be done from the assets that have been transferred. The rationale behind this is
to get the social contact and hotel-style living that these places provide, while still
getting the one to one care that many individuals need. Without Medicaid, one to one care
in such a facility would probably at least double the cost. It should be noted that even
then the cost would be less than the cost of a nursing home.