Posted on February 14, 2014 by Gregory Herman-Giddens

Elder Care Trend: Avoiding Nursing Home Care

at home elder careNew reports from The Washington Post show that baby boomers are electing in-home medical care in lieu of nursing home services. From 1990 to 2010, the number of Americans over age 65 living in nursing homes nationally has dropped 2%, according to the Census Bureau. However, North Carolina is slow to catch on to the trend. Despite the fact that in-home care (often supplemented by family caregivers) is often more economical, long-term care Medicaid in North Carolina primarily provides assistance paying for nursing home care. In 2007, 48.9% of Medicaid funds spent on the elderly in North Carolina was for nursing facility care—a 6% jump from 2006.

Independence comes at a cost. How can seniors in North Carolina cover the cost of at-home care if they do not have the means to privately pay for the level of care they need? Here our elder law attorneys in Chapel Hill offer a few options:

Medicaid’s Community Alternatives Program. The Community Alternatives Program for Disabled Adults (CAP/DA) provides funds for in-home services for Medicaid applicants who need nursing home level care. Even if a Medicaid applicant is eligible for this program, each county has a limited number of CAP slots, so most counties have long waiting lists. Additionally, the program does not provide sufficient funds for 24-hour “custodial” care as would be available at a nursing home. Therefore, in order for a person eligible for this program to receive the benefit, at-home care must be provided privately full-time until the person makes it off the waiting list, and then must continue to be privately supplemented after the person begins receiving the CAP/DA services. Since the person is eligible for Medicaid, this means that s/he does not have the resources to afford private care; therefore, the private care is generally provided by either a family caregiver, an in-home caregiver paid for by another family member, or a combination of both.

Money Follows the Person. Money Follows the Person (MFP) is a demonstration project that promotes bringing persons already living in an institution home. It coordinates with CAP and other community-based services. Persons selected to transition home through the MFP program are given priority on the community services waiting lists, but MFP funds cover the first year of services, as well as providing additional funds to help facilitate the transition from institutional care to in-home care, such as accessibility modifications and improvements to the home to make it a safe place to live. This program tends to be more suitable for those with physical and mental disabilities as opposed to the elderly.

Program for All-Inclusive Care for the Elderly. Program for All-Inclusive Care for the Elderly (PACE) is a managed care program for the elderly that utilizes an adult daycare program to help those needing nursing home level care continue to live at home. Only a few regions in North Carolina currently offer the PACE program. Two such programs have started to serve the Triangle region in the past year.

Veterans Benefits. Veterans may be eligible for benefits that help cover the cost of in-home care, which may be provided by private home health aides or, in some situations, a family caregiver. Read about pending legislation affecting Veterans benefits.

These are just a few ways seniors in North Carolina and their families can manage in-home healthcare costs. Receiving medical care at home often offers more comfort to seniors and their families. While it would be more economical for Medicaid to provide in-home services in most cases, Medicaid regulations unfortunately funnel many elderly adults into a nursing home. However, for those seniors fortunate enough to have family members who are able and willing to help and to supplement their care and expenses, there may be some public benefit options available to help defray those costs.

On March 4, 2014, TrustCounsel’s Chapel Hill estate planning and elder law attorneys Gregory Herman-Giddens and Kristin Burrows present “A Lawyer’s Perspective: Financial and Legal Strategies and Planning, and Assistance Paying for Long-Term Care” at the Senior Center in Pittsboro, North Carolina. 

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