Mom Fell, What Should We Do?

Those words are all too common for families with elder parents. Falling is the single biggest reason people end up needing long term care, either at home or in assisted living or in a nursing home. Obviously the first line of defense is to take all possible steps to avoid falls, but inevitably it happens to a certain percentage of elders. The question “What should we do?” has three major parts.

The first is what injuries did she suffer and how does that affect her activities of daily living. Can she dress herself? Can she bathe and toilet herself? Is she an overall safety risk? If she cannot do those activities without help, she needs long term care. A spouse or children may be able to give that care if their health, work schedule, and place of living allow it. But in many cases it is just not practical for a family member to give enough care.

The second question is where should she receive that care? Is the house or apartment on one floor? Is a part time aide able to give sufficient care? Or is her level of care too much for one person? If so, assisted living may be the answer. But for those who cannot do two or more activities of daily living, either a full time in home aide, or as a last resort a nursing home may be needed.

The third question is how can the family afford to pay for that care? Round the clock care, or nursing home care costs far more than any typical family can afford. The answer is the State of Connecticut has homecare programs for those who can get by with a moderate amount of care, and for round the clock home care for those who can qualify. Connecticut has some of the strictest eligibility rules in the country, but if mom can qualify, it is possible to get 24 hour live in support. The state requires that the caregiver get at least five hours of uninterrupted sleep every day, and it will pay for that care, and under the Adult Family Living Program it can be paid to a family member who is not the spouse.

Knowing the rules to physically and financially qualify is critical if a nursing home is to be avoided. But if the level of care and kind of care is just too much for home care, then the nursing home rules must be satisfied. In a past column I wrote that for any typical family (not multimillionaires) with both husband and wife alive, it is possible to get 24 hour live in care paid by Medicaid if the 5 hours per day sleep requirement is met. The application requires all financial records of both spouses for the five years prior to eligibility. That alone can be a nightmare. Moms’ assets have to be below $1,600, but for the typical family there are many rules and regulations that can be used to structure assets in a way that will result in eligibility. There are simply too many variations among thousands of families to give any simple answer, but that is why getting comprehensive and sound advice from those who can evaluate what kind and how much care is needed, which companies can give it and are approved by Connecticut for payment, or which facility may be most appropriate for mom. A Medicaid organization called the Life Care Planning Law Firms Association is comprised of attorneys who have the staff and knowledge to help people choose the appropriate level of care, where it can be given, and how to pay for it. As one of the original members of this organization, I can say that between the elder care coordinators, the Medicaid and VA paralegals, and elder law attorneys, a comprehensive plan can be made to get the care mom needs in the best living situation possible and to protect some or all of the hard earned money that mom and dad worked hard for over decades.

A primary reason to protect as much money as possible is that if mom needs that care, at home or in a facility, dad will not be impoverished and can maintain the home. That is why the law was passed many years ago.

It does not take a village to keep mom safe, but it does take people who can evaluate what care is needed, how much, and could it be at home. Then it takes people who know where that care can be given, and if at home, what companies qualify for Medicaid. Life care planning attorneys call this a life care plan, which is the whole goal of keeping mom safe and in the best living situation possible while preserving some or all of the family assets using the Connecticut programs and possibly VA aid and attendance for veterans, and widows of veterans. There is no one size fits all answer, but if your family is faced with long term care for mom, get that comprehensive plan in place for her sake, and yours.