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Different Levels of Care = Different Ways to Pay

In last month’s article, Julie Arndt shared the story of Izzy and Dean to illustrate that the need for care often does not happen overnight and there are different levels of care. This month, I would like to discuss those different levels of care and their respective payer sources for each.

Homecare. Often times, as our mobility decreases, our ability to safely bathe, or maybe sight decreases, help coming into the home is an option to help us stay in our own homes longer. Sometimes it is only a few hours a week and sometimes it is more.

We sometimes hear from our clients that “my neighbor’s daughter” comes in to help and we “just pay her cash”. At those words we cringe with the possibilities. First, if your helper should get hurt, you probably are not carrying worker’s compensation insurance to cover her injuries so you will have to pay for those medical bills out of your own pocket. Second, if you have paid her more than $600 during a calendar year, you are required to report that to the IRS. If you have not, you, and she may run afoul of the IRS laws. Nobody needs that problem! We normally recommend that you hire a home care “agency” for help. Let the agency worry about the legalities and you relax and enjoy your life. Additionally, if you are ever in a position to apply for Medicaid, you will run into problems. Medicaid generally will call any payments made in the absence of a formal employment contract gifts and thereby disqualifying you from Medicaid despite what may have really happened.

Homecare can be paid by the following: Privately, Medicaid, Long Term Care Insurance, VA or in some cases, by insurance. There are some agencies that accept Medicaid waiver and there are also agencies that accept other VA programs (beyond VA Aid & Attendance). Other than private pay, coverage for homecare is most often limited to a finite number of hours. Also, if you are a veteran or a surviving spouse of a veteran, there are VA Aid & Attendance benefits that may increase your income in order to have extra money to pay for the homecare. Homecare coverage through Medicare or private insurance is typically based on a “skilled care” need that requires a physician’s order and clinical supervision such as a nurse or therapist. If skilled homecare is involved, there is a possibility that Medicare/insurance will also pay for a home health aid to provide assistance with personal care during the period in which insurance is approved. The good news is that there are a lot of options out there for homecare. You need to know what you need and where to get it.

Often people become isolated in their home and are in need of social interaction and stimulation but they really don’t need a lot of help. There are several facilities in the area that have independent living apartments in a community setting. Some of these facilities are HUD qualified to get some help in paying and others are strictly private pay. You should tour facilities now in order to know your options.

Assisted living is just that – you need a little more assistance with your daily activities of living. You have your own apartment but in a community with the assistance of 24 hour care. Assisted living is generally private pay. There are some area Assisted living facilities that accept Medicaid. VA benefits can also be very helpful in paying for assisted living costs for veterans and their surviving spouses. Many Long Term Care insurance policies have an Assisted living benefit, but not all.

Supportive living is a classification of facilities in Illinois only. Supportive living facilities are assisted living facilities that will accept Medicaid. They accept private pay and also currently qualify for VA expense as well. VA benefits can help with the cost of Supportive Living.

Nursing homes are the types of facilities with which most people are familiar. Historically when you could no longer live in your own home, it was Zero to 100 and straight into full-fledged nursing homes. That is no longer the case as I have discussed above. However, when the time comes that your care does require a nursing home, there are options.

Some nursing facilities are strictly private pay only. Most of the nursing homes in the Quad City area have beds that are licensed as private pay, some that are Medicare only and some that are Medicaid only and some that are dual certified for both Medicare and Medicaid. There may even be a difference between the beds in the same room! Not all facilities are the same and it is important to know your options when that time comes

Over 70% of nursing home residents across the nation need to access Long Term Care Medicaid to pay for their care. That is a staggering statistic. Medicaid has volumes of rules and regulations and are difficult, at best, to navigate. The rules for long term care Medicaid (or Institutional Medicaid) are different than rules for other types of Medicaid. In this area, we have two states from which to choose. The rules are very different in Iowa than in Illinois. It is important that you consult with someone very fluent with years of experience in Medicaid rules when considering Medicaid. We often liken it to a maze built on a minefield. Navigating Medicaid is not for the faint of heart.

You have options. It is important that you know your options and for you talk to an experienced person in the field of senior issues. GolderCare offers FREE Senior Service Consults which is a 1-hour consultation with a Social Worker just to get you started and give you some general information to point you in the right direction. GolderCare can also do in-depth, personalized consultations with you and your family to discuss housing options and strategies specific to your individual situation. Give us a call and we can discuss which would be best for your needs.

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