Caregiver Tip of the Month

Contrary to popular belief, Medicare pays nothing for long-term care. It doesn't matter if the care is provided at home, in an assisted living facility, or in a nursing home.

Perhaps the confusion arises because Medicare can pay for some nursing home care for recovering patients. This is called skilled nursing care. It typically lasts an average of just 23 days while patients recuperate to the point where they can be sent home to complete their recovery. As long as they continue to be eligible, Medicare will pay 100% of their eligible expenses for the first 20 days, and all except $114 a day (2005 amount) for up to 80 more days. After they have recovered sufficiently, Medicare's benefits stop even though the patient may remain in the nursing home as a permanent long-term resident.

On the other hand, Medicaid (MediCal in California) pays about half of all nursing home expenses. But, relying on Medicaid reduces a senior's options to just one – a Medicaid nursing home with at least one roommate (no privacy). If local homes are full, the senior must go wherever a bed is available, even if it is hours away from family and friends. While no one really knows how this affects people with advanced Alzheimer's or senility, it can be devastating for a frail elderly person who is still mentally alert.

9 out of 10 nursing homes that accept private-pay patients also participate in the Medicaid program. If your loved one is not on Medicaid when they move into one of these homes, they cannot be discharged later if they run out of money and have to go on Medicaid. But, the nursing home can move them, without anyone's permission, into a lower-cost room, including a ward-type room with several roommates, or into a special Medicaid section of the facility.

To help avoid that possibility, we recommend that you look over your loved one's finances with the goal of stretching their available funds to last as long as possible. That may mean they won't be able to afford the most luxurious facility. But, the good news is that nursing home care is not as expensive as it seems at first. Instead, to an extent that varies from one person to another, it simply involves a shift of expenses from one living arrangement into another.

After an elderly person's capabilities have declined to the point where they need to move into an nursing home, the move is almost always permanent. When their former home is sold, or its lease terminated, most of the expenses they had been paying for it can then be used to help pay their nursing home expenses. Another way to boost income is to use the money from the sale of their home to, for example, purchase a CD or annuity that pays monthly interest. To find out what their home is worth, click on home valuations.

Also, since nursing home fees include all meals, your loved one will no longer have to buy groceries, thereby freeing up even more money. To help you evaluate your loved one's financial situation, we've included a worksheet, Finding the Funds for Long-Term Nursing Home Care.

The worksheet assumes that no assets are being spent down; in other words, they will remain intact with only the interest/dividend income they produce being used to supplement your loved one's income. But, if they are short of the funds needed for nursing home care, some or all of their assets will have to be spent down. That is, the principal value of an asset will have to be converted into a stream of monthly income payments. When doing so, several factors need to be kept in mind. Among them ...

Our visitors ask ...

Q. Are there any programs in _________ that will help seniors with heating repairs and home repairs? I know a senior who needs home repairs but she can't afford to pay for it. She doesn't have heat and will not leave her home. I invite her to come to my house but she fears missing someone calling her to give her help. Can someone please help; the temperature is dropping fast. She has already been sick with a bad cold.

A. Call the Eldercare Locator. Developed by the U.S. Administration on Aging, this is a free nationwide directory assistance service. It helps older people and their caregivers find local support services to help them live independently in their own community. Call their toll-free telephone number 1-800-677-1116, between 8am and 9pm weekdays, Eastern Time.

Important Reminder: We live independently for most of our adult lives. But, many seniors are ashamed or embarrassed to ask for help when they age and can no longer do everything for themselves. As a result, it is important to periodically check on our elderly friends and neighbors year-round, especially during the cold of winter and the heat of summer. Even if they've tried and failed to get help locally, the Eldercare Locator may have other local contacts for the help they need.

Daily Living Solutions

— products for seniors —

As we grow older, it often becomes difficult to use many everyday products because of arthritis and other conditions. If you or a loved one needs a little help – or a lot – we've selected a group of practical and affordable solutions from our affiliated merchants to help overcome those limitations.

Whether you are looking for yourself, or to help an elderly senior continue living in their own home, you'll find a wide variety of supplies and accessories – raised toilet seats, safety rails, incontinence supplies, large-handle eating utensils, pain relief, diabetic supplies, pill splitters and crushers, big-button telephones, canes, walkers, rollators, wheelchairs – and much more.

Everything is sorted into convenient categories in our Solutions for Seniors section.

Caregiving – Finding the money for care at home

A variety of resources can help pay for care at home. We discussed these resources in some detail beginning with the May 2004 issue of this newsletter and continuing each month through the August issue. To review these newsletters, simply click on Archives and select the issue you want to see.

Caregiver Tip #2

— Prescription Drug Interactions —

Prescription drugs interactions – are they a problem for your loved one? Most seniors take one or more prescription drugs every day; one-fourth take 4 or more. Seniors are often given new prescriptions without thoroughly assessing their other medications. Dangerous interactions and side effects – even disastrous consequences – can result. Professionals estimate that 1 in 4 hospital admissions of seniors result from medication problems, including prescription drugs interactions. According to Consumer Reports on Health, "Any new health problem in an older person should be considered drug induced until proven otherwise." (For more information, click on Prescription Drugs Interactions and Seniors.)

Our visitors ask ...

Q. My 87 year old mother-in-law requires complete home care. She receives Social Security and a pension amounting to $1,400 per month. This amount would cover the cost for her care. My wife and I are living on Social Security, and I would like to know if we have to pay taxes for providing home care for my mother-in-law.

A. Whomever your mother-in-law pays to provide her home care will have taxable income. If she is "paying" you and your wife for her care, she has "hired" you and could be your "employer" in the eyes of the IRS. As a result, you will owe income taxes on at least a part of what she pays you, and she could be required to file additional tax returns. Fortunately, many out-of-pocket expenses related to home care are tax-deductible if certain requirements are met. That would reduce the overall amount of your taxable income.

Your situation is probably more complex than you would like, with possible adverse tax results if not handled correctly. Talk to a experienced financial advisor such as a CPA for more specific advice. Or, speak with an attorney who specializes in elder law. Check the yellow pages in your telephone directory, or go to the National Academy of Elder Law Attorneys' website. On their home page for the public, you'll find a link in the upper left corner (just below their logo) that will help you locate an elder law attorney.

Recommended Reading and Videos

Many excellent books and videos can help guide you through the caregiving process. For our recommendations, including a brief description of each one, click here.

The material on this site is for informational purposes only, and is intended as a supplement, not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider. More