Worried, overwhelmed, exhausted and stressed are words family caregivers use to describe their experience. The local chapter of a health advocacy group did an informal survey of its members aimed at understanding the experience of family caregivers, those who are providing care to a loved one with a health need. These are spouses, adult children, nieces and nephews, even elderly parents caring for an adult child.
Caring for someone else full time is an enormous undertaking and usually so demanding that many caregivers lose sight of taking care of themselves with breaks and rest. Mixing in the emotion of caring for a family member while watching them age or watching their health decline makes the job feel even more consuming. Regrettably, these roles change the dynamics of the relationship too, making time together more about the checklist of tasks instead of simply sharing company or having fun.
Families explore help from numerous resources and decide a family member should provide care for a number of reasons. Sometimes it’s comfort, preference, or fear of the unknown, but most of the time, it’s the cost.
The 2019 Genworth Cost of Care Survey conducted by CareScout suggests that in-home companion care for regular daily living activities like dressing, bathing, meal preparation, etc., averages almost $25 an hour. For 40 hours per week, that totals $4,200 per month, or well over $50,000 annually. Regardless of a family’s income or savings, that’s a lot to add into any budget.
There are some resources available to pay for long-term care, but they are sometimes misunderstood. Medicare is usually the first to be explored. This traditional health insurance available to everyone at age 65 does cover long-term care, but very specifically for rehabilitation in a nursing facility after discharge from a hospital stay, and only for 100 days at most. Some families have long-term care insurance, which will only sometimes pay for in-home care. There’s also the option of paying for in-home care with savings or by liquidating other assets, but this can quickly deplete even a healthy nest egg.
In Delaware, the Medicaid Long Term Care Program covers all three levels of care – skilled nursing facilities, assisted living facilities and home based care. In-home care falls under the Home and Community Based Waiver Program. There are usually steps required for a person to financially qualify, but the program is an incredible resource for hundreds of community members from all financial backgrounds.
In Delaware and Maryland, it makes sense to explore the Veterans Aid and Attendance Pension as another resource for in-home care. This income stream is approved for veterans or their surviving spouses during a need for care.
The Medicaid HCBW offers up to 72 hours per week of in-home care, based on the healthcare needs of the person applying. The caregiver paid to work those approved hours can be a professional, family member or friend. All of the recipient’s monthly income is retained to cover normal living expenses, including but not limited to the mortgage payment, utilities, groceries and maintenance. The robust program includes a number of other benefits in addition to the weekly care hours, such as adult day services, respite care, home-delivered meals and emergency response systems.
Recipients can choose their caregiver(s), weekly schedule and preferred services. Families can explore the numerous reputable in-home caregiving agencies in the area. Agencies will work to pair the clients’ and caregivers’ personalities from the start, and if a provider isn’t a good fit, families can ask the agency to make a change. They can also choose a family member or friend to provide the hours. With a caregiver selected, recipients can choose their preferred schedule, like using hours in the morning to provide for a bathing and dressing routine or using hours in the evening while a primary caregiver is working.
The rules to become financially eligible for the Home and Community Based Waiver Program and Veterans Aid and Attendance Pension may appear complex and restricting. Families should consult with an experienced elder law attorney to understand the eligibility strategies available to them, while simultaneously sheltering their savings. The planning is legal, ethical and fully disclosed to the Medicaid Long Term Care Program.
Elder law attorneys introduce this benefit as a viable resource to clients every day, and it’s rewarding to help facilitate much-needed help. Family caregivers can gain relief, rest, and time to take care of themselves.