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The
payment structure of the American health care system has
historically forced many elders to go to nursing homes to
get the assistance they needed because the government would
not pay for the same services in their home – even though it
would be far less expensive to do so. There has been
significant progress in this area, however, both in the
financing and philosophy of community-based care. Several
programs are available to provide elders with the personal
care they need to remain in the community, along with
non-skilled services such as laundry and shopping and
payment of room and board in luxury assisted living
facilities. And, although many elders presume they are not
eligible for financial assistance for community care, most
can become eligible for some assistance with proper
guidance. Following is a very brief description of some of
these programs.
Program of All-Inclusive
Care for the Elderly (PACE)
The
PACE program is a comprehensive health program that is
designed to keep frail, older individuals who are certified
eligible for nursing facility services living in the
community. The “community” may be an elder’s home or one of
several assisted living facilities that contracts with
PACE. In cases in which an elder can no longer safely
reside in the community, the elder is easily transitioned to
a nursing home within the program. All services are
provided by PACE staff, including primary medical care, home
health services, adult day health, rehabilitation programs,
transportation, medications, social services, meal program,
dental services, vision services, and much more. To be
eligible, applicants must be aged 55 or older and meet
financial and other criteria, although there is also a
private pay option. Elders with monthly income of $1,809 or
less may be eligible for PACE at no cost.
Group Adult Foster Care (GAFC)
and Supplemental Security Income-G
Elders who are eligible to receive an SSI Living Arrangement
G Supplement (income of $1,077 or less per month)
automatically satisfy the financial requirements of the GAFC
program, which is administered by the Division of Medical
Assistance. GAFC subsidizes the cost of personal care and
case management services to residents of GAFC-approved
assisted living facilities and elderly and disabled public
housing. The SSI-G supplement is applied to room and board.
Personal Care Assistance
Program
Disabled seniors may qualify for the Personal Care
Assistance (PCA) program. Under this program the Division
of Medical Assistance will reimburse Medicaid recipients for
personal care assistants. The elders are responsible for
hiring and supervising the assistants, who provide personal
care and non-skilled services such as laundry,
housecleaning, and shopping.
Medicaid Home Care
The
Frail Elders program will provide MassHealth benefits for
community care to elders who are clinically qualified for
nursing home care if they have monthly income of $1,809 or
less. It is particularly important to consider this option
for married couples, as the assets and income of the healthy
spouse may be waived from consideration if the applicant is
at least 60 years of age, certified as requiring a nursing
home level of care, and otherwise eligible for Medicaid.
In addition, Governor Romney signed the “Equal Choice” bill
into law on August 3, 2006. Elders and disabled persons who
are eligible for Medicaid will now have a choice of going to
a nursing home or obtaining the services they need in the
community, and pre-admission counseling will be required for
any prospective nursing home residents to ensure that they
are informed about the community care options. This law
also increased the asset limit, making these benefits
available to more elders.
Other Options
Long-term care insurance is an option that is
under-utilized, particularly for elders that own their own
homes. Elders who are able to qualify medically for
long-term care insurance can combine a Medicaid-qualified
policy (one that provides a minimum amount of coverage as
outlined in the regulations) to provide “lien-buster”
protection for their homes with an inexpensive policy for
home-care services only to ensure that they can obtain the
care they need to remain in their homes.
Reverse Mortgages are also under-utilized because many
elders do not realize that this area is now strictly
regulated by the government. Unfortunately, first
impressions are often lasting impressions so the reputation
of pre-regulation Reverse Mortgages has been difficult to
dispel. Reverse Mortgages are not the solution for every
elder, but they should certainly be given appropriate
consideration with all of the other options for financing
long-term care.
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