The Toughest Decision You’ll Ever Make
A friend or family member has been declining.
An event occurs.
They go into the hospital.
And suddenly they’re facing the choice of whether they
can return home or whether they need to be placed in
an institutional setting.
This is not a question of “for the time being.” This is
about the rest of his/her life.
New Words and Difficult Questions
The person you care for needs “long term care.” Long term care is not about doctors and nurses, it is distinct from “skilled care.” Rather “long term care” or LTC as it is often called, is about a person’s ability to care for themselves – that is, their ability to perform so-called “activities of daily living,” or ADL’s.
LTC is most often a function of cognitive decline, which may be accompanied by physical limitations or “deficits.”
To understand the options, it sometimes helps to break it down into parts. Considering these questions can sometimes help:
What Does S/He Want?
Most people want to stay home. Some people want to stay home so desperately that there really is no choice. They won’t accept any other option, and would rather die sooner in their home than live longer someplace else. Other people might like, or at least benefit from, being around others. They might be more social, and the isolation of their home setting might actually contribute to their decline.
What Does S/He Need?
While most people want to stay home, they may need care that is only available in an institutional setting, or that is impractical to bring into a home. For those that need a limited amount of supervision, assistance preparing meals or taking medications, for example, in home care might work.
What Can S/He Afford?
The cost of LTC is steep, beyond the budget of most middle-class Michiganders.
Assisted Living Facilities (“ALFs”) may range from $3,000 – $5,000 a month, and nursing homes (“SNFs”) are even more, upwards of $10,000 per month. Bringing professional caregivers into the home
is expensive as well, typically $15 to $20 per hour.
As a result, notwithstanding what people want and what people need, most decisions about LTC placement are heavily weighted by what they can afford. This leads to the question of whether they can qualify for government assistance through Medicaid, or less frequently, the Veterans Administration (“VA”). Both of these programs have complex eligibility rules which look at assets, income and whether
someone gave any property away prior to applying for benefits.
Long Term Care planning for Medicaid or VA benefits is a major part of an elder law practice. Unfortunately, these benefits are also commonly discussed at so-called “educational seminars” held regularly at restaurants and public places, at which attendees are given bits and pieces of frightening information as a part of a program designed to sell things like annuities and “irrevocable” trusts. Honest and competent advice about Medicaid and VA benefits is not so easy to find.
Finally, there is the issue of who can make these decisions, which requires understanding the differences between medical and financial power of attorney, wills and trusts, guardianship and conservatorship.
Decisions about long term care for older adults are complicated and require those in the position of making decisions to understand legal documents, care needs and the nuances of complex government programs. The crazy thing is that people are making these decisions every day, under pressure, in a time crunch, and with no help.
Luckily, you already know where to go for information and sound advice.