Studies show that older Americans prefer to stay in their own homes if they possibly
can. It is no surprise, then, that most care for the elderly is provided at home,
whether by family or by hired help. While many consider in-
To begin with, family members shoulder most of the burden of caring for the elderly at home. Being the primary caretaker for someone who requires assistance with activities of daily living, such as walking, eating and toileting, can be a consuming and sometimes exhausting task. One important consideration when one family member bears the sole responsibility of caring for a parent or other older relative is the question of equity with other family members. For example, is the family member being fairly compensated for her work? If the older person is living with a child, does the parent contribute toward the home expenses? If the care is taking place in the elder's home, does the child have an ownership interest in the house?
For parents with only one child, such arrangements may not be so complicated, but if the parent has more than one child, it can be difficult to know what is fair. An arrangement that seems equitable today may not seem that way after a child has devoted, for example, five years to the care of the parent. And if a plan is set up that is fair for five years of care, what happens if the parent suddenly moves into a nursing home during the first year? With no planning for such eventualities, the care of an older person can foster resentment and guilt among family members. Fortunately, most elder law attorneys are skilled in helping families devise creative solutions to such problems.
At the same time, state and federal government officials are slowly recognizing that
home care can be more cost-
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Public and private agencies offer a variety of home care services that may be available to you, including the following:
Medicare and Medicaid provide some coverage of the medical portion of home health
care. Although the coverage is often inadequate, when combined with other resources
available to the older person and his or her family, it may be enough to keep a fragile
older person at home for a longer period of time. For an explanation of the coverage
of home health care available under Medicare, click here. Medicaid offers very little
in the way of home care except in New York State, which provides home care to all
Medicaid recipients who need it. Recognizing that home care can cost far less than
nursing home care, a few other states -
There are thousands of private home care agencies around the nation. About half of these are Medicare or Medicaid certified agencies, meaning that these two federal programs will reimburse for services provided by the agency if the services are covered. Such certification also means that the agency has met certain minimum federal standards regarding patient care and finances. Home care agencies can also gain accreditation from private accrediting organizations. The three major accrediting groups for home care agencies are the Community Health Accreditation Program http://www.chapinc.org; the Joint Commission on Accreditation of Healthcare Organizations http://www.jcaho.org; and the National Association for Home Care http://www.nahc.org.
The new profession of "private geriatric care manager" has evolved to help coordinate
services for seniors. Private geriatric care managers usually have a background in
either social work, nursing, or psychology and are experts in helping older persons
and their families make arrangements for various kinds of long-
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Caring for a loved one with a long-
There are many different types of respite services:
The cost of respite services varies from service to service. Medicare does not pay for these services, but Medicaid may pay for adult day care services. There may be other federal or state aid available. Contact your local Area Agency on Aging for more information.
To find respite services, go to http://www.respitelocator.org/ or contact your local Area Agency on Aging. If you are caring for an Alzheimer's patient, your local may have support groups and other help for caregivers.
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Seniors who cannot afford other retirement homes may be able to qualify for federal
or state funded low-
In both programs, your rent is calculated as a percentage of your income. The exact percentage varies from program to program and state to state, but it is usually around 30 percent or 40 percent.
Each program has different eligibility requirements, and the exact requirements vary from state to state. In general, the criteria for eligibility are your age, household size, income level, and immigration status.
To apply, you need to request an application from each housing authority or program you want to apply to. For information on what housing is available in your state, go to http://www.hud.gov/groups/seniors.cfm.
Unfortunately, there are often more applicants than housing available. As a result, housing authorities and landlords keep applicants on waiting lists. These waiting lists can be quite long. Because of the wait, it is important to apply to as many different housing programs as you can, and to keep track of your applications and your place on the waiting lists. Also, if you move, be sure to notify the places you submitted applications.
Certain applicants may be able to get a preference or priority status on the waiting list. The particular preferences and priorities vary from program to program but common ones include:
If you fit into a preference or a priority, you may be moved up the waiting list.
Once you reach the top of the waiting list, the housing authority or landlord will determine whether you are income eligible. Then they will check certain information, such as credit reports, criminal record information, and landlord references, to determine if you are likely to be a good tenant. Once that is completed, you can move in.
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The reality is that it is sometimes impossible or too expensive for an elderly person
in poor health to remain at home. Other seniors may simply wish to live with others
rather than be isolated. Fortunately, over the last two decades there has been an
explosion of supportive housing alternatives for seniors, and the options are no
longer limited to an agonizing choice between staying at home or moving to a nursing
home. If you (or a loved one) do not require round-
Supportive housing options range from board and care homes to large institutional complexes. Supportive facilities provide food, shelter and personal assistance while encouraging independence and personal dignity. The services offered may include help with activities such as eating, dressing, preparing meals, shopping, as well as monitoring and other supervision.
The main alternatives are board and care facilities, assisted living facilities and
continuing care retirement communities (CCRCs). But these broad categories encompass
a huge range of options in terms of services and costs. Generally, the more you pay,
the more services you get. There is a great disparity in quality as well, with facilities
ranging from excellent to sub-
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These are group residences that can range in size from as few as two residents to
more than 200. They may also be referred to as residential care facilities, homes
for the aged, or community-
Such facilities generally do not provide any medical services. These homes may be unlicensed, and even licensed homes may rarely be monitored by the state. Costs can range from $350 to $3,000 a month. For those with very limited incomes, Supplemental Security Income (SSI) may help pay the cost of these homes. Medicaid may also reimburse the monthly fee, depending on the state and the resident's Medicaid eligibility.
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These facilities offer basically the same services as board and care homes, but in a more "upscale" and homelike environment. Housing is often in small apartments and there is generally more space, privacy and recreational options. A premium is placed on retaining as much independence in living as possible, and care is more individualized. Despite the emphasis on independence, supportive services are available 24 hours a day in order to provide different levels of help with activities of daily living. There also may be more medical supervision than is available in a board and care home, depending on the facility.
While costlier than board and care facilities, assisted living facilities nevertheless are often less expensive than a nursing home. Assisted living facility residents agree to pay a monthly rent, which can range from less than $2,000 to $6,000 a month. According to a 2009 MetLife survey, the average cost of an assisted living facility in the U.S. is $3,131 a month, or $37,572 a year. The highest average monthly cost was in Wilmington, Delaware, at $5,219 a month while the lowest was in North Dakota at $2,014.
This rent may cover all services or there may be charges for services above the monthly
fee on a per-
However, assisted living facilities are an emerging industry and not all states regulate such centers to protect residents from substandard care or questionable business practices. The National Center on Assisted Living compiles an annual list of state regulations that includes contact information for licensing agencies.
Whether assisted living facilities are regulated or unregulated in your state, asking specific questions can help you gauge the quality of a facility. For a checklist of questions to ask of assisted living facilities, click here.
In addition, visit the Web site of the Assisted Living Consumer Alliance (ALCA),
a national non-
For names of assisted living facilities near you, the following are several helpful sites: Senior Housing Net (www.seniorhousingnet.com), Your Senior Resource Guide (www.yoursrg.com) and ElderCarelink (www.eldercarelink.com).
Fighting an Assisted Living Discharge
When you move into an assisted living complex, you expect to spend the rest of your days there. However, many assisted living residents suddenly find themselves facing eviction from their homes when their health deteriorates. Although there is no "one size fits all" way to handle a discharge from a facility, there are some things you can try.
In general, assisted living facilities have a lot of discretion to determine when to discharge a resident. According to the National Senior Citizens Law Center, 39 states allow a facility to discharge a patient if the facility can no longer meet the patient's needs. The other 11 states (Connecticut, Georgia, Kentucky, Maryland, Massachusetts, Minnesota, Nebraska, New Hampshire, New Jersey, North Dakota, and Rhode Island) are either silent about discharge or provide other reasons for discharge, such as the resident requires services that exceed the facility's license or the resident violating the admission agreement.
Almost all states require facilities to give residents notice of discharge, but the rules vary widely from state to state. In addition, laws regulating assisted living facilities are vague. While this gives facilities a lot of discretion, you can also use it to your advantage.
If you are facing a discharge that you don't believe is fair, you should stay put,
if possible. In a few states (Massachusetts, New York, and Iowa), assisted living
discharge is considered an eviction and is handled under landlord-
Some states may have procedures by which you can object to the discharge. The procedures vary from state to state. It could be that you meet with a staff member or an administrator who made the discharge decision or file a complaint with the state licensing board. In a few states (Maine, Ohio, Oklahoma, Oregon, Vermont, Wisconsin), you have the right to an administrative hearing.
If all else fails, you may be able to use anti-
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CCRCs offer the entire residential continuum-
CCRCs are so diverse in their offerings and personality that the saying in the industry
is that "if you've seen one CCRC, you've seen one CCRC." The physical plants of CCRCs
run the gamut from urban high-
Most importantly, CCRCs guarantee a life-
The downside of CCRCs is the cost, which can be greater than what people with low or moderate income and assets can afford. Prices depend on the amount of care provided, the type of contract, and the unit's size and geographic location. Entry fees run from $20,000 to more than $500,000, with monthly charges ranging from $200 to $3,200. Often seniors use the proceeds from the sale of their home to make the initial investment in the retirement community. However, the Internal Revenue Service does not allow home sellers to roll over their capital gains into the purchase of a CCRC unit. Thus, a tax may be due on gains from the sale of a home even though a CCRC unit is being purchased with the proceeds.
You may be entitled to a refund of your entry fee on a declining scale if the refund is requested within a short time after moving in. Generally a refund will no longer be available after a specified period of residency. Some CCRCs give residents the option of paying a higher entry fee, which remains refundable. Part of the entry fee will be refunded either to the resident when the resident moves or to the resident's estate once the resident dies.
CCRC Fee Arrangements
The number of payment options is growing. Although the entry and monthly fee arrangement is the most common, some CCRCs offer rental or equity arrangements. Under a rental arrangement, residents pay only a monthly fee, which typically covers housing and designated services (sometimes including health care services). Under equity arrangements, residents purchase their residence in the same way they would purchase a cooperative apartment or condominium, although the resale of the unit is usually limited to those who meet the community's eligibility criteria. Residents then may purchase service and health care packages for an additional fee.
CCRCs usually have the following three basic fee schedules:
Extensive contracts, which include unlimited long-
Contracts have gotten more confusing over the years, with many CCRCs offering different
variations within each fee schedule. For example, a CCRC might offer two different
extensive contracts and one modified contract, with different levels of refundability
for each. At www.ccrcdata.org you can find a directory of CCRCs and sort them by
location, price, long-
As with assisted living facilities, the regulation of CCRCs is spotty. These institutions
are strictly regulated in some states, while not at all in others, and there is no
overarching federal agency that watchdogs retirement communities. A private non-
Nevertheless, a CCRC's lack of accreditation should not necessarily be taken as a
bad sign. One of the most important considerations is the financial soundness of
the facility. In selecting a community, experts recommend choosing a "mature" facility,
one that has been in business a number of years. In addition, it is important to
know who the CCRC's sponsor is. The Society of Friends (Quakers), for example, has
been in the CCRC business for quite some time and its facilities are reputed to be
excellent. The American Association of Homes and Services for the Aging is the national
ssociation for the non-
CCRC Entry Requirements
Most CCRCs require that a resident be in good health, be able to live independently
when entering the facility, and be within minimum and maximum age limits. As a prerequisite
to admission, facilities may also require both Medicare Part A and Part B, and perhaps
Medigap coverage as well. A few are now even requiring long-
CCRC residents usually fund their care out of their own pockets. However, Medicare,
and at times Medicaid, can be used to pay for certain services, and most CCRCs accept
either Medicare or Medicaid. Although Medicare does not generally cover long-
How to Evaluate a Facility and Contract
Deciding on a CCRC is a once-
For a checklist of questions to ask of CCRCs, click here.
For an article on the growing options offered by CCRCs from the New York Times and reprinted in the International Herald Tribune, click here.
National Center on Assisted Living's Annual Reference List
The National Center on Assisted Living compiles an annual list of state regulations that includes contact information for licensing agencies. While helpful for beginning research, it does not include citations or listings of resident rights.
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DISCLAIMER: This information was originally obtained from www.elderlawanswers.com and has been updated. The updated information is based on new and/or revised federal, state, or local laws, with some of the updated information applicable to citizens with residence in the state of Tennessee. The effective date of all changes and/or revisions to the information contained on this site: TUESDAY, JANUARY 1, 2013.
The information on this web site is a public resource of general information, which
is intended, but not promised or guaranteed, to be correct, complete and up-