Posts Tagged Eldercare

Why Seek Advice for ALTCS?

As life expectancies and long term care costs continue to rise, the challenge quickly becomes how to pay for these services. Many people cannot afford to pay $4,000 per month or more for the cost of a nursing home, and those who can pay may find their life savings wiped out in a matter of months, rather than years.

Fortunately, the ALTCS Program is there to help. In fact, in our lifetime, ALTCS has become the long term care insurance of the middle class. But the eligibility to receive ALTCS benefits requires that you pass certain tests on the amount of income and assets that you have. The reason for ALTCS planning is simple. First, you need to provide enough assets for the security of your loved ones. Second, the rules are extremely complicated and confusing. The result is that without planning and advice, many people spend more than they should and their family security is jeopardized.

Exempt Assets and Countable Assets: What Must Be Spent?

To qualify for ALTCS, applicants must pass some fairly strict tests on the amount of assets they can keep. To understand how ALTCS works, we first need to review what are known as exempt and non-exempt (or countable) assets. Exempt assets are those which Medicaid will not take into account (at least for the time being). In general, the following are primary exempt assets:

  • Home, no matter what its value. The home must be the principal place of residence. The nursing home resident may be required to show some “intent to return home” even if this never actually takes place.
  • Personal belongings and household goods
  • One car or truck
  • Burial spaces and certain related items for applicant and spouse
  • Up to $1,500 as a burial fund for applicant & spouse
  • Irrevocable prepaid funeral contract
  • Value of life insurance if face value is $1,500 or less. If it does exceed $1,500 in total face amount, then the cash value in these policies is countable.
  • Miller Trust (or Income Only Trust) – see our website for more information

All other assets are generally non-exempt, and are countable. Basically, all money and property, and any item that can be valued and turned into cash, is a countable asset unless it is one of those assets listed above as exempt. This includes:

  • Cash, savings, and checking accounts, credit union share and draft accounts
  • Certificates of deposit
  • Savings Bonds
  • Individual Retirement Accounts, (IRA), Keogh plans, (401K, 403B) (Exempt for the community spouse)
  • Nursing home accounts
  • Prepaid funeral contracts which can be canceled
  • Trust (depending on the terms of the trust)
  • Real estate (other than the residence)
  • More than one car
  • Boats or recreational vehicles
  • Stocks, bonds, or mutual funds
  • Land contracts or mortgages held on real estate sold

For assistance with qualifying for ALTCS please reach out to one of our specialists.

How To Pay For Nursing Home Care

One of the most difficult transitions people face is the change from independent living in their own home or apartment to living in a long term care facility or nursing home. There are many reasons why this transition is so difficult. One is the loss of a home…a home where the person lived for many years with a lifetime of memories. Another is the loss of independence. Still another is the loss of the level of privacy we enjoy at home, since nursing home living is often shared with a roommate.

Most people who make the decision to move to a nursing home do so during a time of great stress. Some have been hospitalized after a stroke, some have fallen and broken a hip, still others have progressive dementia, like Alzheimer’s disease, and can no longer be cared for in their own homes.

Whatever the reason, the spouse or relative who helps a person transition into a nursing home during a time of stress faces the immediate dilemma of how to find the right nursing home. The task is no small one, and a huge sigh of relief can be heard when the right home is found and the loved one is moved into the nursing home. For many, the most difficult task is just beginning; how to cope with nursing home bills that may total $2,500 to $6,000 per month or more?

One of the things that concerns people most about nursing home care is how to pay for that care. There are basically four ways that you can pay the cost of a nursing home:

  1. Long Term Care Insurance – If you are fortunate enough to have this type of coverage, it may go a long way toward paying the cost of the nursing home. Unfortunately, long term care insurance has only started to become popular in the last few years and most people facing a nursing home stay do not have this coverage.
  2. Pay with Your Own Funds – This is the method many people are required to use at first. Quite simply, it means paying for the cost of a nursing home out of your own pocket. Unfortunately, with nursing home bills averaging between $4,000 and $6,000 per month in our own area, few people can afford a long term stay in a nursing home.
  3. Medicare – This is the national health insurance program primarily for people 65 years of age and older, certain younger disabled people, or people with kidney failure. Medicare provides short term assistance with nursing home costs, but only if you meet the strict qualification rules.
  4. ALTCS (Arizona Long Term Care System) – This is a federal & state funded and state administered medical benefit program which can pay for the cost of the nursing home if certain asset and income tests are met.

If you are looking for assistance in qualifying for ALTCS please reach out to one of our specialists at Legal Awareness for Seniors.

 

What is Spend Down for ALTCS

When qualifying for ALTCS (Arizona Long Term Care System) otherwise known as Medicaid many applicants will come to learn the term “spend down”. If you have too many assets when you apply ALTCS will deny you. In order to qualify you will need to spend down your assets.

The assets you have cannot be given away, but they can be spent on certain exempt resources. ALTCS looks back five years to check for gifting. They want to assure that you are spending your money on your own needs and not the needs of family or friends.

Some of these qualifying exemptions are:

  • Funeral trust
  • House
  • Car
  • Personal items (clothing, medications, appliances, etc.)
  • Care needs
  • Legal fees, such as estate planning
  • Miller Trust (or Income Only Trusts)

There are means to avoiding spend down. You will want to be sure to get quality legal advice or speak to one of our knowledgeable estate planners to help assure ALTCS will accept you.

Caring for Aging Parents with Your Siblings

Caring for an aging parent can be a struggle alone, but add in your siblings and things can get stressful. It is important to work together as a team to support your parent. You may each have a different idea of how your parent should be taken care of which can cause stress and tension. At the same time your parent is aware that they are relying more and more on their children and are probably not happy about it.

Caring for a parent is a shared responsibility. It is important, however, to assign a primary care provider. Consider who is the most dependable, has the most time to devote to their parents care, and who is emotionally prepared to fill this role. Once that is established you can decide what the other siblings roles will be and what they can provide.

It may be best to schedule a family meeting. Make sure everyone has time to discuss their feelings and how they see the care being handled. If you feel there will be contention it may be best to host the family meeting with a facilitator such as a social worker, family friend or other trusted person outside the family. To have a productive meeting try these guidelines:

  • Set an agenda for the meeting.
  • Focus on the now – try not to bring up issues from the past.
  • Share how you feel instead of accusing others (keep your sentences using ‘I’ instead of ‘you’).
  • Listen and respect what others are saying. Give everyone time to speak.
  • Find a way to come to a compromise. Everyone may not get their way, but at least you can all come to an understanding. Everyone may have to give a little.

If you find that anyone in particular doubts that their parent needs care have them spend a week or even a day with the parent to see a first hand view of the issues.

It is also important to have your parent draw up an Advanced Health Care Directive. They have an idea of who they want to make their major decisions and they should have a choice in the matter.

The Difference Between Hospice, Palliative and Respite Care

Learning the different types of care that are available can be important on making the right decision for your loved one.

Hospice Care
This is designed to make the last days, weeks or months of the terminally ill and their families more comfortable. Hospice will comfort the patient emotionally and physically as best they can as well as help the family with the transition and decisions they will need to make. In the United States there are about 40% of patients in Hospice Care that receive the care at home. Patients that are transferred to Hospice Care are referred by their doctor and usually have six months or less to live.

Palliative Care
This type of care is for anyone that is having a major health crisis and needs help managing it. They are not necessarily at the end of their life. This type of care helps patients manage pain, stress, depression, and physical ailments. The care providers will focus on relieving and prevent the patient from suffering.

Respite Care
This is a short-term stay at a community or assisted living facility. This is most commonly used for seniors who are living with their children. This gives them a break from each other or gives the family security knowing their loved one is being cared for while they are traveling.  Respite Care is also used to ease your loved one into assisted living, giving them a trial run of what life may be like in a senior living community.

Myths About Assisted Living

In the past 20 years Assisted Living has become more and more popular. Since it is essentially a newer concept there are some false ideas many have around Assisted Living Facilities.

Myth #1 Assisted Living = Loss of Independence
Assisted Living Facilities actually promote independence. They strive to make things easier on their residents so they are able to live their lives more freely than they would if they were living on their own. They encourage stimulation and social interaction to help maintain independence as long as they can. In fact, many facilities even allow you to keep and use your car as long as you are able.

Myth #2 Seniors will be isolated in a facility
The opposite of this is true. Retirement communities are where seniors end up developing close friendships and social connections. When they live in a facility they end up being busier than ever with fun events and activities planned out for them.

Myth #3 An Assisted Living Community is another way to say Nursing Home
They are actually completely different. Nursing Homes focus on the medical needs of their residents and the therapies they need in order to stay alive. Whereas Assisted Living Facilities provide the support their residents need with housekeeping, meal preparation, activities, and social interaction in order to assist them with their independence as long as possible.

Myth #4 Assisted Living is only for the wealthy
These facilities are for everyone. If you take in the cost of living at home, even if your mortgage is paid off, you will find it is very similar. With the cost of home maintenance, property taxes, groceries, utilities, transportation and other living expenses it can add up. You won’t have any of those costs with Assisted Living; it is included in the monthly cost. This is especially true if you need the assistance of a private duty caregiver.

Myth #5 You can’t take your pet with you
There are many Assisted Living Facilities that welcome your well-behaved four legged furry friends. Studies have shown that those who have a pet live a longer and healthier life. Don’t let the fear of having to leave your pet behind be a factor in your decision. Those facilities that allow your pet to live with you are out there.

Myth #6 The meals are not appetizing
Actually the meals that are prepared are carefully planned and prepared with the nutritional needs of the senior population in mind. The meals are homemade and well thought out so that they are enjoyable, maintaining the quality of life their residents are use to. It is even advised that you sample the cooking before making the decision to move into the facility.

Myth #7 Assisted Living Facilities are filled with residents that are sick or dying
Assisted Living Facilities are full of seniors who no longer wish to live alone and require additional support in order to maintain the life they are accustomed to. Without assisted living the resident’s health would have declined more rapidly and would instead be admitted directly into a nursing home or hospice. Assisted Living Facilities strive to keep their residents healthy and alive as long as possible. In fact, most homes require that the new resident be partly independent when entering the facility.

Decorating Tips for Assisted Living

When moving into Assisted Living you will want to create a space that you feel comfortable in. It will be much smaller than the home you are use to living in. We have put together some tips to help you when decorating your new space.

1. What is important to you
When moving into a smaller space there are many things you will need to let go of. Go through and find sentimental items you will want to see every day such as pictures, books, and décor – but keep it simple as to avoid cluttering the new smaller space. Consider gifting items you won’t be taking with you to family or friends, anything else can be donated.

2. Consider size for furnishing
It is important to keep in mind the size of your new environment. You may not be able to bring your entire sofa set, but your love seat might fit perfectly. Avoid keeping any deep, cushy couches; more firm cushions will be easier to get up from as you age.

3. Choose optimal colors
As we get older our eyesight changes so it is important to use colors that are great in contrast. Keep in mind that certain colors inspire different feelings; blue is calming, yellow is uplifting, etc. You can liven up a room just by adding colorful throw pillows. Primary colors (red, yellow and blue) are ideal for dishes which give a great contrast to the food.

4. Find unique storage ideas
A convenient way to store items is to have an ottoman that can also be used for storage. You can have a tray to place on top of the ottoman to double as a coffee table. Corner bookshelves or armoires are space savers as well. Use end tables and night stands that have drawers for extra storage.

5. Stage the area for falls
As we age it is easier to slip and fall. Keep walkways clear of area rugs and cords. Any furniture used should have a curve to the sides instead of having a sharp corner or glass. Set up furniture as another use for support to walk. Have plug in lights along the walkways for ease of use at night.

6. Incorporate activities
Make books, playing cards, puzzles and other activities you enjoy easily accessible. Have a house plant to talk to and water to keep stimulation. Keep your personality in your décor and you will thrive.

Moving Your Parents To Senior Care

Planning the move: Even if the choice is theirs to move, it can be a very emotional time to leave behind a home that your loved one has lived in and cherished. You should encourage a meaningful farewell. Invite friends and family over. Have a nice dinner together. Go through each room and talk about memories and special events. Let them say goodbye in their own way.

How to pack: Since your loved one is most likely moving into a smaller space there are items that must be given away. It is important to not insist they throw things out. This is a very emotional time. It may be better to let them keep any items that are hard for them to get rid of and give them time to discard them later after thoughtful contemplation. You will want to pack items that will help to create an environment they are use to.

Setting up the new environment: It is important to imitate a familiar scene in their new environment. A good example is to arrange the bedroom so when they wake up they see the same set up as they did at their home. You can recreate the living space with their familiar photos, décor and books – but avoid clutter. Keep in mind that it most likely will be a smaller set up than they had before.

Settling in: While getting them familiar with the new facility and the new residents you will also want to get familiar with the staff. Find out if there is a designated point person to discuss wishes and issues with. In turn, give them a designated point person for them to contact in case of emergencies or questions. You will also want to be familiar with any routines such as housekeeping, meals, outings, etc. This will help you to plan any visits and help your loved one adjust.

Dealing with Eldercare Guilt Part II

Previously we discussed things that may cause guilt when you move your loved one into a care facility. Dealing with this guilt can be hard on you and everyone around you. There is a three step strategy that will help you cope with the guilt you are feeling:

  1. Identify the feeling. The first step is realizing you are having these feelings. There are many ways that you can tell if guilt is surfacing:
    1. You may feel the need to constantly be at the facility
    2. You may feel depressed or anxious
    3. It may be hard for you to enjoy yourself
    4. You may scrutinize the facility and the care they are giving, even if it is excellent care
    5. You may find yourself in a cycle of guilt, then relief, then guilt
  2. Identify your expectations. Once you know that it is guilt you are feeling you must realize what expectation(s) you have set that is not being met.
  3. Look closely at the expectations to see if they are reasonable. If they are not realistic then you must realize you need to let go of the guilt. If they are realistic, you need to come up with how you will handle the situation differently next time. You may even want to take a closer look at your decisions and come up with a better plan.

In the end, you have taken the time to make the best decision for you and your loved one. It may take time for your heart to catch up to what your head already knows. Take the time to work through this guilt so you and your loved one can have the best relationship possible through these difficult times.

 

Dealing with Eldercare Guilt Part I

Making the decision to place your loved one into a nursing home are care facility can bring on many emotions. One of the most common emotions children of elderly parents face is guilt. This is a normal feeling and may take some time to overcome. Some of the most common reasons for guilt are:

  • Feeling like you have failed. Moving your loved one into assisted living does not mean you are a failure, in fact, you are ensuring that your loved one is receiving the best care. This is a great accomplishment. It is hard for many to ask for help, but realizing it and doing something about it is much more beneficial for everyone involved. You did not make this decision lightly, and now you need to realize that this was the right decision. It is also important to focus on the small victories to help get past the guilt.
  • Feeling as if you are not as good of a caregiver as others. You are a great caregiver; it is not fair to compare yourself to others. Everybody’s circumstances are different. The reality is that your parent is in need of more assistance and requires a higher level of care than you are able to provide.
  • Thinking their health wouldn’t have become worse with the move. Realize that you did not cause the illness. Your loved one would continue to suffer whether you were the one caring for them or not. If you feel that they are being ignored or abused you must reach out to get help. If they are being well taken care of, you must realize that illnesses progress no matter what. It may be true that things would be different if you continued to care for them at home, but you made this decision for a reason and their health may even actually be worse if they were still at home with you instead of in a care facility.
  • Feeling you are not spending enough time with them. You will still be your loved one’s advocate and spend as much time as you can with them. You can get involved with their community by participating in events to help your loved one adjust more easily. Find new ways to express your care and love for them by doing something special such as reading a book together, bring them a flower everyday, and go through photo albums together.
  • You find you are losing patience with them when you visit. When you schedule times to visit them it is best to go after you are well rested or have taken some time for yourself first. If you notice that you are starting to feel aggravated when visiting it is a good sign that you need to take a break. It is hard to switch care giving roles with your parent and can get frustrating at times.
  • Finding it is hard to taking time for yourself. It is important to take time for yourself; this gives you the ability to work past your guilt. Take the time to see a movie, exercise, and do what needs to be done. Your feelings of guilt should not keep you from living your life. Once you have met your own needs it will be much easier to help take care of the needs of your parent.

Don’t be afraid to speak with a professional to get through the guilt. It may also be helpful to find yourself and advocate that you can vent to. You may even reach out to a group that supports adults with parents in care facilities. You don’t have to go through this alone.