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.

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.

Agency personnel are bonded and insured.  Do you really want to take the risk that something can happen with your hire that will leave you with no recourse?

Even if you find someone you can trust how will you finalize the arrangement?  Does he/she get an annual raise?  Does he/she get vacation?  What happens when he/she can’t come on a particular day?  Who provides backup?  When we used an agency and the first companion decided this was not the right match, they provided another in home companion in a week.  How will you handle such an issue?

Agencies also know their limits.  In-home companions can not give out medication. Nurses are required when injections are administered.  Do you really want to fool around with this?

Another issue is withholding taxes and social security payments.  Imagine you don’t pay them to save some money and then you have to fire them.  They go to the unemployment office and when asked who they worked for the last two years and he/she says you.

The unemployment office contacts the I.R.S. and they come after you for back taxes, interest, and penalties.  Who needs such grief?

Stick with an agency

In order to allow him to go grocery shopping we hired the services of in home care service.  The agency provided a companion who, once a week, took my father-in-law shopping, did light house work and laundry.  He also reported to us anything that he though was out of sync.  For example, he told us that there were times when there was no laundry to wash.

This in home care service was a wonderful addition to our lives.  My father-in-law asked for so little.  It made us so happy that we were able to give him the opportunity to still attend the concerts that he loved so much.  We would not have been able to do without the companion service.

A companion is not allowed to bathe the client or give out medication.  There is usually a four hour minimum and you pay the agency directly.

If you are contemplating hiring a service here are some of the things you should look for:

Are they licensed?

Are they accredited?

Are they bonded?

In our case, the owner did the initial assessment.  Who does the assessment for your company?

What guidelines do the companions have to follow?

Make sure they know what you expect of them.  Let them know if any rooms are out of bounds.

I told our companion about my father-in-law’s  background so that he would have a better understanding of him.  Be sure you fill them in also about your LO.

These in home care agencies made all of our lives so much better.