What makes my Action and Implementation Program unique is that I look at elder care from the caregiver’s point of view. My experience and that of many other care givers is summarized below:

1. One person bears most, if not all, of the work.
2. Unless you’ve done this before you have no idea of the amount of work involved.
3. The annoying attitudes or habits of your Loved One (LO) do not go away merely because they get old.  Those habits only get worse.
4. Federal or state governments or your relatives will not voluntarily reimburse you for any money you spend on elder care.  Out of pocket expenses average $500.00 a month.
5. The intersection of inheritance and elder care will set powerful emotions into play.  You have to look out for your interests.  I’ll tell you how to prepare for visits with your lawyer.
6. The perception of what relatives think is due to them from an inheritance can over ride rational decisions or compromises.  I’ll show you how to negotiate with your relatives.
7. The efforts you make in elder care will be heavily discounted by your relatives.
8. Day to day life may go on uneventfully, and then a crisis (a fall, a stroke, or an accident) will occur that changes everything.
9. Elder care can go on for longer than you expected.
10. You have to take action to prevent becoming isolated and overly stressed.
11. Taking care of your needs is not a luxury, it is a necessity.
12. You love is not going to save them.

Go to HomeCareSurvival.com for a free DVD about elder care.

To find out what other programs are available go to http://www.benefitscheckup.com/ and fill out the questionnaire.  It takes about thirty minutes to complete but when you finish you will know all the local, state, and federal programs that can help you pay for you mom’s care.

Use the Institute of Financial Planners at www.ICFP.org or call 1-800-322-4237 to find a certified financial planner to help you sort through your parent’s financial affairs.

A reverse mortgage could free up money to pay for their care.  There are issues you need to consider when thinking about a reverse mortgage.  Go to the National Center for Home Equity Conversion at www.reverse.org for critical information.

I have other phone numbers and web sites for the legal, housing, and medical aspects of eldercare that I’ll get out to you shortly.

Or you can go to HomeCareSurvival.com and sign up for my Action and Implementation Program.

The guidelines for what is covered vary from state to state and the amount of money available to pay for Medicaid covered services are subject to political forces.  To find out what those guidelines are in your state and which program is the best for your elderly parent, contact your local Area Agency on Aging.

The Qualified Medical Beneficiary Program is for those people who are at or below the poverty level which is defined as $4,000 in financial assets for an individual or $6,000 for a couple.  The state will cover the premiums and deductibles.

Specified Low Income Medicare Beneficiary Program is for those people who are 10% above the poverty level.

If you plan on using Medicaid for your elderly LO you should contact an elder law attorney who specializes in filing Medicaid applications.  The attorney will also advise you on how to manage your LO’s financial assets.

You need advice of what expenses are eligible and which are not.  You do not want the state to come after you to reclaim money to reimburse it for the expenses they covered.  Go to naela.com for a listing of elder law attorneys.

Hospitalization, doctors’ visits, and medications are covered.  Not all doctors take Medicaid so you have to find one that does and be prepared to wait for an appointment.  If you can’t wait for an appointment then you will have to go to the emergency room for treatment.

Most states have a waiver program that pays for services at home instead of placing your LO in a nursing home.  If your LO qualifies for admission to a nursing home but would prefer to live at home you might be eligible for PACE (Programs of All-Inclusive Care for the Elderly).  Your LO will be provided with all that he/she needs to live safely in their home.

Visit Medicare.gov/Nursing/alternatives/PACE.asp for more details.

Call your Area Agency on Aging or the State Health Insurance Assistance Program (SHIP) for information on the PACE program or any other issues regarding Medicare or Medicaid.

Be aware that if your LO wants to get out of the HMO they have to apply for Medi-Gap insurance which could be more difficult if they develop a new health issue.  They may not get guaranteed access to a policy.
Doctors and hospitals can go in and out of an HMO which may leave you with fewer options.  When you inquire about joining an HMO find out how many doctors have left.  Ask about switching doctors if your doctor leaves or if you are dissatisfied with his/her service.
Since the elderly use so many prescriptions, be sure they can fill your current medications.  Find out how often they update their formulary.  How and who determine what is medically necessary and how can you appeal that decision?  What happens when your LO needs emergency care while traveling beyond the area covered by the HMO?

Medicare has different parts.  Part A covers the hospital costs of people over 65.  It also covers people under 65 who have kidney failure.  It is paid for by contributions from employers, employees, and the self-employed and from premiums deducted from the social security payments of the person receiving the coverage.  The premiums are deducted automatically from their Social Security payment.  If your LO is not receiving Social Security there is a seven month enrollment period, three months before their 65^th birthday and four months after.  Be sure they don’t miss this enrollment period.

Medicare does not cover long term or custodial care, which is what elder care usually involves.  The services that are covered have to be prescribed by a doctor and provided by a Medicare approved facility.

Medicare Part B is paid for by the premiums of people who voluntarily enroll.  The federal government pays the rest.  Medicare Part B covers physicians’ costs, lab costs, outpatient care and certain home care services.

If your parent is covered by another form of insurance, such as a retirement program, he/she may not want to enroll in Part B.  If that is the case he/she must let Social Security know about their decision.

Medicare Part B covers 80% of the bill. The remaining 20% has to be covered with a separate insurance policy.  We used the AARP program and were very satisfied with it.  We had the premiums automatically deducted so there would be no gap in the coverage.

When buying the Medi-Gap insurance make sure that it does not exclude pre-existing conditions.  Be sure also that they buy the policy within six months of turning 65.  If you enroll during that period, the insurance company can not charge more because of any pre-existing condition.  As always, fill out the insurance application completely.  Don’t give the insurance company a reason to refuse claim.

To get more information on Medi-Gap insurance go to Medicare.gov or call your local area agency for aging.

In the next post, I’ll describe Medicare HMO’s and Medicaid.

If you are just getting started to figure out your parent’s current financial condition there is an easy way to find out if there are funds available to help you.  Go to benefitscheckup.com and answer the survey.

There are questions about your parent’s financial condition, the housing arrangements, and what medications they are taking.  The survey takes about thirty minutes to complete.  When done the web site will produce a list of all the federal, state, and local programs that your parent(s) qualify for.

Why not take advantage of the programs that already exist to help you help you take care of your elderly parents?

A recent article in a local newspaper describes a service has taken both ideas to a new level.  The author, Ronald Roel, answered a question about elder care planning for the reader’s 83 year old mother.

Roel acknowledged that some elder law attorneys specialize in certain aspects of elder care such as Medicaid application, or estate planning.  He pointed out that some elder care attorneys are now offering Life-Care Plans.  According to Roel, Life-Care Plans “bundle services such as asset protection and Medicaid qualification with care coordination, nursing home advocacy and crisis intervention.’

“The principal goals are to help people obtain appropriate care at home, in an assisted living facility or, if necessary, a nursing home, help make decisions relating to health care, long term care and special needs through later stages in life; and help find the best resources to pay for such care.”

The services that Life-Care Plans provide are paid for on a retainer basis for a specified period of time.

I like this idea.  It is a holistic approach and because relatives have to be involved it puts them on notice.  They cannot escape their responsibilities.

Remember the idea is to use their assets to provide for their care.  Their assets may not be enough however to cover the expense of home care.

The first way to understand what programs are available to help you and how you can access those programs is to go to benefitscheckup.org.

Benefitscheckup.org is a service of the National Council On Aging.  You will be asked to supply information about your parent’s current financial condition, their housing situation, and their medical needs.  Based on their responses you will be given a list of the programs that are available to you in your area.  The survey takes about thirty minutes to complete but it is worth the time.

The second thing to do is to review their social security statement for accuracy to be sure that they get all the money due to them.

The third thing to do is to sign up for a supplemental medical insurance policy.  This will cover the 20% that Medicare does not cover.  Without this coverage they or you  could be stuck with huge bills.  For example, Medicare covers twenty days of rehab and a supplemental insurance policy covers an additional eighty days of rehab.  If you didn’t have that coverage you would have to pay for the rehab.

We used the AARP program and had it deducted automatically from his account.  This way there was no way the bill could be overlooked and his insurance canceled and we stuck with the bills.

In one family, the mother-in-law relocated from Long Island to California to be near her daughter.  The mother was living in a continuing care community and she loves being there.  She is making friends and is very contented.  The mother has enough assets to allow her to live there for four years.   After that time the three children will each contribute to keep her living there.  There are assisted living and nursing home facilities on campus should she need them.

This is the first time I have come across such a wonderful solution.  I’ve been looking for this type of cooperation for a long time.  I was beginning to think it didn’t exist.  I’m so happy for her and her family.

In the other family, the mother lives next door to her daughter.  The family knew at some point the mother would need some help.  This became obvious when the mother could no longer walk up the stairs to take a shower in the upstairs bathroom.  She had to go next door to her daughter’s house.  They did not remodel the bathroom in the mother’s house during the three years this was going on.

Then the mother had a stroke.  She was in rehab and would be getting out in ten days.  Because of complications from the stroke she would not be able to go next door to take a shower, she would have to shower in her own home.  That meant they had to expand the existing half bath into a full bath.  In less than ten days.

Fortunately, they had contacts in the construction business and were able to get it done.  But, why did it have to come to this?  Why didn’t they see what was going to happen?  What else are they overlooking?

Amazing, isn’t it?

In the previous post, I looked at two suggestions that Dan Taylor uses in his book, The Parent Care Conversation namely Challenges and Alternatives.  The next two steps are Resources and Experience.

The hardest part with Resources is trying to get your LO’s to think differently about their  situation.  To free up their minds to what they can use for their care.  They may not realize how much is available to them to help them solve their particular problem.  If home care is new to you also you may not be aware of the resources available.
One way to remedy that is to contact the Area Agency for Aging in your county.  This is a governmental agency that was set up to provide information about what programs and facilities are available for the elderly.  The agents can give you the direction you need.

I would also suggest that you consult an elder law attorney.  You can find one through the National Academy of Elder Law Attorneys on their web site naela.com.  If your parents don’t have he financial resources for their care the attorney can prepare the application for Medicaid.  If they have assets the attorney can advise you on inheritance issues or how to turn those assets into cash for your LO care.

Based on what challenges they are facing and after discussing the alternatives and resources the next step is to get your LO to describe what outcomes they would like to Experience.  The purpose o this is to get them to see that with planning and support they still can use their remaining years to achieve some of the goals they set for themselves.