Activities of Daily Living

Every day of our lives we perform basic functions that are known as activities of daily living (ADLs). They are dressing, bathing, eating, toileting and making transfers on and off chairs, and in and out of bed. We take these for granted as we go about our daily routines. But when the frailties of age, sickness, or mental capacity become so diminished that someone cannot do these basic needs of living, then outside help is needed. That help typically comes from a spouse, or adult children, but if there is no spouse, or children do not live nearby, or when it is simply not practical for family to help, then homecare agencies must be hired to keep that elder person safe at home. Families then need to pay for that help out of their own resources until they can qualify for government programs. If the elder person cannot do three or more activities of daily living, then the Connecticut Home Care Program for Elders (CHCPE), or Medicaid will pay for help with the things the elder cannot do, if the elder person qualifies financially and functionally.

The state evaluates what help is needed and calculates the cost of that care. The state will pay up to $3,685 per month for care. If the elder person is on the state funded program, there is a 3% co pay for that care. For those who qualify, the Connecticut Home Care Program for Elders will pay up to $7,370 per month towards care, using Medicaid. Should the elder person need a live-in caregiver, the caregiver is required to have at least 5 hours of uninterrupted sleep per night. That means a family member must provide the extra care, or pay another agency, so the paid caregiver can get the necessary sleep.

The state will send someone to evaluate what activities of daily living the applicant cannot do. The state will also require an accurate list of assets and income to determine financial eligibility. The applicant or healthy spouse can keep a house with an equity limit of $1,071,000, plus up to $154,140 of countable financial assets. In short, a typical husband and wife can usually qualify to get significant care to keep the one needing care at home. Although the rules are strict, many people can qualify. Very few states have such good home care programs and that means their residents may be forced to choose a nursing home.

It is my experience that most family members try to give 24 hour care by themselves, wearing themselves out from the strain. A quote we often use is that “The only worse thing than one sick person, is two sick people.” The wise approach is to get care in the house before the caregiver spouse or child becomes so worn down by the physical and mental strain that they cannot continue, and may need care themselves. That way the chances of the sick person staying at home increase significantly. Keep in mind that 24 hour care is simply the maximum, and in many cases far fewer hours are needed to keep a person at home.

It is also my experience that the second hand information and rumors about losing assets are hugely inaccurate and scare people from pursuing the outside homecare services and programs to pay for that care. The rules in Connecticut are quite fair and designed to keep families together, and at home, if at all possible. If both spouses are alive and one is healthy, the rules usually allow the healthy spouse to keep most of the couple’s hard earned assets. The healthy spouse must then do a special will that has provisions to protect most of those assets if the healthy spouse should die first. Every family’s situation has unique circumstances, but it is safe to say that a plan can usually be designed to take care of the needy one, and preserve the family assets. If your family has a loved one whose ability to care for themselves is obviously declining, the wise approach is to seek the information and advice of what help is needed, how much, and if the Connecticut Home Care Program will pay for some or all of that care.

Attorney Stephen O. Allaire is Of Counsel and Attorney Halley C. Allaire is principal in the law firm of Allaire Elder Law, members of the National Academy of Elder Law Attorneys, Inc., with offices at 271 Farmington Avenue, Bristol, (860) 259-1500, or on the web at www.allaireelderlaw.com. If you have a question, send a written note to either attorney at Allaire Elder Law, LLC, 271 Farmington Avenue, Bristol, CT 06010, and they may use your question in a future column.