Miscellaneous Long-Term Care Planning Info and Options

Andrew M. Brower

In prior blogs, I have discussed Medicaid options for skilled nursing and the Special Assistance Medicaid program for an assisted living facility. In this blog, I will address some miscellaneous items to ponder when long-term care planning.

Assistance for Elderly Veterans

First, is your elderly loved one a Veteran? If so, Veteran’s Aid and Attendance may provide a small amount of assistance with long-term care cost. For a wartime veteran that meets the income and asset tests (or for a surviving spouse of a wartime veteran), the VA Aid and Attendance program may help pay for some of the costs for an assisted living facility. Generally, the applicant can have a house, vehicle, personal effects plus about $123,600 to qualify. A single veteran may receive a little over $1,000 a month if they qualify for Aid and Attendance. Beware, there are new rule changes effective October 1, 2018, about gifting penalties for this VA benefit.

Additionally, if approved for Medicaid in a skilled nursing facility, the applicant will be required to apply for VA benefits if they or their spouse was a veteran. If eligible for VA benefits, the applicant may be able to keep more than the standard $30 allowance when receiving skilled nursing Medicaid.

Veteran’s Aid and Attendance may also help to pay a small stipend towards at home caretakers.

What about care at home?


Most families want to keep their aging loved one at home as long as economically and medically feasible. Unfortunately, daily home care requires private pay in most cases, which is a good reason to plan ahead by making wise financial decisions to have plenty of retirement savings. However, you also need to have a plan for when care at home is no longer a viable option either monetarily or health wise. While no one wants to put their loved one in an assisted living or skilled nursing facility, at some point, care at home becomes economically and medically impractical. Institutional care can also have benefits such as allowing your aging loved one to stay social, which can have a positive impact on maintaining their mental faculties as they age. Medicare plans can sometimes pay for basic in-home health care visits. But for skilled care or any type of daily supervision, there are limited options other than privately paid caretakers.


How do I know if it’s time for placement?


The first step for making a placement decision is typically an assessment. To receive Medicaid in a long-term skilled nursing facility one must be deemed to be skilled level care by a physician and have an FL-2 completed.

What is the Program of All-Inclusive Care for the Elderly aka PACE?


There is a program available called PACE, which is a day program for elder adults designed to keep their health from regressing to a need for 24/7 skilled care. It is also a great way for your loved one to maintain a social life and preserve their mental faculties as they age. It can be a great situation when one spouse is sicker than the other and the healthier caretaker spouse needs a breather during the daytime hours, but is able to provide adequate care in the evening and overnight hours. The PACE applicant must be deemed to need skilled nursing and for Medicaid assistance must be eligible for Medicaid under all of the rules to receive skilled nursing Medicaid benefits, including the 5-year review. An individual on PACE currently gets to keep $1,012 of their monthly income and must pay the rest to the PACE facility. The combination of Medicare and Medicaid (if eligible) benefits can pick up the rest of the cost.


What is the Community Alternatives Program for Disabled Adults aka CAP?


CAP is a program for in home care which Medicaid will pay for, if eligible, but it can sometimes have a long waiting list and limited resources depending on your County. Additionally, there is a monthly income limitation for CAP which is currently a gross income of around $1,071 per month.

Lastly, to qualify for CAP, caretakers will be required during off hours because CAP does not provide 24/7 care. Your home must also be handicap accessible. To receive CAP benefits you must meet all of the skilled nursing Medicaid eligibility requirements including the 5-year review.

While CAP is often not a viable option because of income or otherwise, it could be right for your loved one depending on the circumstances.

To speak with an attorney about long-term care planning, please call anyone of our offices.