Aging in Place

What happens when an elder reaches the point where he or she can no longer live independently and be safe at home? Must he/she move in with a son or daughter or vice versa? What if that is not feasible? What options exist to provide in-home support so the elder can “age in place”?

Meals on wheels is run by Highland Valley Elder Services “HVES”. Modest services such as check writing/bill paying and minor household chores can also be obtained through HVES. But what happens when the care you need exceeds that which is provided by these sources and/or your family and friends? There are a couple of government programs that may support you, but they are not necessarily the white knight who can fix the situation when the elder needs a great amount of care. Medicare does not pay for long term home care. Medicaid (also known as MassHealth) is the primary rescuer. But Medicaid is needs based. You only get it if you need it, and you only need it if you satisfy certain clinical and income and perhaps, asset criteria.

Under Medicaid’s Personal Care Attendant (PCA) program the elder must meet certain clinical criteria such as the need for help with transfers from chair to bed or with bathing, etc. If the elder does have those needs, and his/ her income is low enough, then he/she should qualify. This program would then award a certain number of hours of a care attendant based on the elder’s needs. Under certain circumstances the elder is responsible for finding that person and the state pays a check to the home care attendant based on the hours submitted to their financial office. Family members other than the spouse can get paid through the PCA program for helping their relative. This is a relatively new development.

Veterans and spouses of veterans who served during wartime may receive a pension through the federal VA Aid and Attendance program. This program is based on income, assets and clinical criteria. The application process takes forever and is quite cumbersome.

There is also a resource known as “Program of All- Inclusive Care for the Elderly” “PACE”. This program is designed for elders who would need a nursing home placement if care could not be brought into the home BUT who are stable and likely to remain in the community a while. The mechanics of the program are similar to an HMO. Once you join the program you must use all of the providers within that group. You are unlikely to continue to use your primary care physician. If you do later need nursing home placement, you must choose one within that provider’s network. You must be able to attend a day program at least twice monthly.

If an elder is not eligible for the PCA, PACE or VA Aid and Attendance programs noted above and has no savings, then the answer to aging in place lies in a home equity loan or reverse mortgage. For the younger generation with resources (for example, a 56 year old retired professor) the answer may lie in long term care insurance with substantial coverage for care in the home.