SUPPLEMENTING MOM’S STAY AT AN ASSISTED LIVING RESIDENCE

The period of time during which people are receiving long-term care is truly becoming long. As the continuum of care extends to include adult communities, home health aides, assisted living residences, continuing care retirement communities, nursing homes, and hospice care – the age at which people enter this continuum slowly lowers and the concomitant length of time that an individual is on this continuum continues to lengthen.

Also contributing to the length of time people receive long-term care is advancement in medicine. People are living longer.

Given the advancements in the type of care being provided – both long-term care and health care – it is common for a person to receive care for ten or more years before their passing. Since long-term care costs a tremendous amount of money – anywhere from $2,000 to $9,000 a month – the question many people find themselves asking is, how can I afford to pay for this?

A family’s first experience with long-term care is often an assisted living residence (“ALR”). ALRs are typically very nice facilities. For the most part, ALRs look like fancy hotels.

Unlike the experience people have with nursing homes, the experience people have with ALRs is typically pleasant and uplifting. I have many clients who reside in this type of residence. Many were very (very) reluctant to leave their home, but once they did, they have found themselves thriving and thoroughly enjoying their experience. If for no other reason, the ability to socialize with people their own age in a clean and friendly environment is a benefit that they may not have enjoyed for years.

As we get older, family members die, friends die, and we become more and more isolated. We see our own mortality, and it frightens us. The ability to share our life experiences with people who have shared similar experiences is invaluable.

Given these benefits and amenities that ALRs offer, a family’s desire to have mom or dad live at such a place for the remainder of her/his life is understandable. Now the problem: Assisted living residences cost between $3,500 and $5,500 a month. If mom’s stay costs $4,000 a month (a cost that will probably rise every year by at least 5%), and if she has net, monthly income of $1,200 and assets of $250,000, her family may have a concern about her continued stay at the residence when her money runs out.

Many residences accept Medicaid. And most – if not all – of these facilities will tell the family that when mom’s money runs out, she can go on Medicaid.

But unlike Medicaid in a nursing home, Medicaid for an assisted living residence has a limited number of “slots.” In other words, when mom runs out of money, she may be placed on a waiting list for the Medicaid program. Since she has no money – she must have less than $2,000 to qualify for the Medicaid program and it is only when she qualifies for the Medicaid program that she can be placed on the waiting list – she only has her $1,200 a month in income.

At this point in time, her monthly care might cost $5,000 a month, so she has a $3,800 a month deficit. Who’s going to eat that deficit? The assisted living residence? The facility certainly has no obligation to do that and could evict mom from the facility. Mom is a month-to-month tenant at the assisted living residence, subject to eviction on thirty days’ notice.

Furthermore, once a person qualifies for Medicaid, the person should be placed in a semi-private room. This may be disconcerting to mom who has lived in a private room for the past five years and considers that room her home.

Lastly, if mom does have to leave the assisted living residence because her health has deteriorated, she will have substantially less or no money. This may cause her difficulty when trying to enter the nursing home of her choice.

Because of these issues, I advise that my clients engage in some form of Medicaid planning. By putting money aside, the family can supplement mom’s stay at the ALR and overall care. When mom’s money runs out, the family will have money to pay for her care while she’s on the Medicaid waiting list. The family will have money to pay the cost differential between a semi-private and private room, so mom can stay in the room she calls home. The family will have money to place mom in the nursing home of her choice if her health deteriorates.