AVOIDING THE NURSING HOME

A common concern is how to avoid a nursing home. Some people profess, "I will never go to a nursing home." In my last visit to a nursing home, it was full and no one I met was there voluntarily. That being said, avoiding the nursing home can become achievable with proper planning. There are three key factors in protecting against the requirement of having to go to a nursing home: (1) You must legally authorize the people you trust to make decisions for you should the need for long-term care arise, (2) You must document your wishes, and (3) You must provide a way to pay for your care at home should the need arise.


Most people believe being married for many years entitles them to make decisions for their spouse, if a health care crisis occurs. That is not always true. If you are single or widowed, it is even more problematic. The more important question is: What decision would you make if something happened to your spouse or loved one? Many think they know what they would do, but in my experience, when put in that position, most are unaware of the severe emotional stress and fears that impact them upon the long-term disability of a loved one.


The key to maximize your options to stay home and avoid nursing homes is to ensure you have properly authorized your loved one to act for you and to ensure you have documented your wishes. This is achieved by a properly executed Health Care Proxy, Living Will and Personal Care Plan. While these documents are readily available at hospitals, senior centers and other public places, you should be warned that not all are the same. Not all versions have the necessary legal language to provide you the maximum protection and control. Getting these documents from such places is like getting your legal documents at a dentist’s office. You should consult a qualified Elder Law or Estate Planning attorney to ensure you have the proper documents to accomplish your objectives.


Once your legal protections are put in place, providing for payment of care needs is critical. The most common ways to pay for care at home include Medicaid benefits, Veterans' benefits and Long-Term Care Insurance. Under the current Medicaid and Veteran’s Administration Rules, most individuals can qualify for benefits within 30 days, if properly advised. Medicaid is a government form of health insurance for the poor, and individuals can qualify for care in the home for as many hours a day determined necessary for their safety.
There is also a little-known benefit for any veteran, or surviving spouse of a veteran, called the Veterans Aid and Attendance Benefit To qualify, the veteran must have served at least 90 days of active duty, of which one of the 90 days would have been served during wartime. This includes World War II, Korea, Vietnam, and even the Gulf War. The veteran need not have been in combat or even traveled to foreign soil, but merely been enlisted during the dates the war was declared. If eligible, a veteran and spouse may be entitled to up to $1,950.00 per month to pay toward any medical expenses, including Medicare premiums, prescriptions and paid care, to name a few. The VA benefit is paid directly to the veteran, or the veteran’s surviving spouse, from the Veterans Administration. A surviving spouse is entitled up to $1,056.00 a month.


Finally, a long term care insurance policy can also enable you to stay at home. While considered expensive by some, the annual premium for a long-term care policy for a couple is often less than one month's nursing home care for one of them. More importantly, a properly purchased long term care policy can provide a home care benefit to pay for healthcare benefits received in the home, and help to avoid the need to go to a nursing home.


Obviously, no one chooses to go to a nursing home. The determination of whether you or a loved one has to go into a nursing home is not dependent upon your wishes, but rather, dependent upon your planning. Make sure your planning is complete, so you maximize your options.