We are going to look at Medicare and in-home care for older people in this post. However, before we get there, we will provide some background information to help you understand the overall dynamic.
Medical Care vs. Custodial Care
There are distinctions drawn with regard to the type of care that you may receive in your home. Medicare will cover necessary health care services that must be provided in your home for approved reasons. Basically, a doctor must certify that you are homebound, and you need an approved type of treatment or service.
When it comes to skilled nursing home care, it is limited to intermittent care. This is defined as care that is not needed seven days a week for durations that are less than eight hours per day. In all, the hours cannot exceed 28 hours in a week. The coverage can extend throughout a 30 day period. However, there can be more than one 30 day interim.
Custodial care is in another category. When a senior needs help with their activities of daily living like bathing, using the restroom, and dressing, they are receiving custodial care. This is not covered by Medicare, and homemaker services such as shopping and cleaning are not covered.
Key Aging and Long-Term Care Statistics
LongTermCare.gov is a website that is maintained by the United States Department of Health and Human Services. They have compiled some eye-opening statistics about seniors and long-term care. You should definitely absorb this information when you are looking ahead toward the future.
According to their research, someone that is reaching the age of 65 today has a 70 percent chance of needing some form of assistance with their daily needs. On average, men need the help for 2.2 years, and it is 3.7 years for women. One in five people that need support will require the assistance for more than five years.
Currently, 42 percent of elders will receive paid living assistance eventually, and 35 percent will reside in nursing homes. The average length of stay for someone in a nursing facility is 12 months.
Long-Term Care Costs
According to Genworth Financial, the median monthly charge for a private room in a Hartford area nursing home was $14,950 last year. The figure was $13,247 for a semi-private room.
For a licensed home health aide, the median monthly expense was $5,577. If you extend that out to a year of care, you are looking at $66,924. If you are married, the expenses could potentially be doubled.
Medicaid Home and Community-Based Services Waiver
Now that we have set the stage appropriately, we can share some information about a possible solution. If you can receive the custodial care that you need in your own home, you may be able to qualify for the Medicaid Home and Community-Based Services (HCBS) Waiver program.
It will pay for a home health aide if you can gain eligibility. In addition, Medicaid will pay for a stay in a nursing home if in-home care is not an option.
Since it is a need-based program, you cannot qualify if you have significant assets in your name. However, if you take the appropriate steps in advance, you can position your assets wisely with future eligibility in mind.
This will typically involve the utilization of an irrevocable Medicaid trust. While you are living independently, you can accept distributions of the trust’s earnings. If you apply for Medicaid at least five years after you fund the trust, the principal will not count.
Schedule a Consultation Today!
Today is the day for action if you are going through life without a plan for aging. You can schedule a consultation at our Glastonbury or Westport, CT elder law offices of you call us at 860-548-1000. There is also a contact form on this site you can use to send us a message.
Mr. Nirenstein is licensed to practice before the courts of the State of Connecticut and the United States District Court. He is a member of the Connecticut and Hartford County Bar Associations, and the Estate and Probate, Elder Law, Business Law and Real Estate Sections of the Connecticut Bar Association.