Coping with Crisis: Getting the Right Help for an Aging Parent

When an older friend, parent or loved one begins to show signs of needing assistance, how do you step in without overstepping?

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It is a call nobody wants to receive: an energetic, independent parent in a distant state is suddenly behaving differently. When Jane first came to Grimaldi & Yeung her mother, Margaret, was in her early 80s and starting to have some health problems. Worse, she was showing signs of confusion. What could Jane do to take care of Margaret without uprooting either of their lives? Grimaldi & Yeung’s attorneys and social workers:

  • Performed a home inspection to determine what supports Margaret would need to remain at home.
  • Created a financial plan — including a trust — to protect Margaret’s assets and establish her eligibility for Medicaid to provide home care services.
  • Put Margaret’s legal documents — including a Durable Power of Attorney, Health Care Proxy and other Advanced Directives — in order so that Jane could direct her care and, if necessary, act as her agent.
  • Helped Jane identify and hire appropriate in-home health.
  • Consulted with Margaret’s physician to create a simplified routine that was easier for her to follow.
  • Held a “summit” with two care agencies to create a structure for Margaret and remove some of the uncertainty in her life.

Structure had become increasingly important for both Margaret and Jane. Additionally, Margaret’s assets needed to be consolidated and protected. Grimaldi & Yeung worked with the two women on a range of levels — legal, financial and human — to help take care of Margaret’s current and anticipated needs without disrupting either of their lives.

Medicare/Medicaid Planning: Home Care

When facing a long-term or serious illness, most people would prefer to be cared for in the comfortable setting of their own homes. The current health care system favors in-home care as a cost-control measure. Typically in-home care is delivered by family members, but sometimes other caregivers are involved. Associated costs are covered in part by Medicare, private insurance and Medicaid. Your Grimaldi & Yeung attorney can help you put together a plan for in-home care — including available services and financing options — that makes sense for you.

Medicare-Financed Home Care

Medicare services are usually provided by Certified Home Health Care Agencies (CHAAs). These agencies range from large non-profits, such as the Visiting Nurse Service of New York, to smaller more customized services affiliated with hospitals or social service agencies. CHAA services are medically-focused, must be ‘ordered” by the treating physician, and are evaluated and supervised by registered nurses. Medicare home care services typically last 4 to 6 weeks and rarely provide more than 20 hours per week. It is intended to be rehabilitative, not long term care.

Private Insurance, Private Pay and Medicaid-Financed Home Care

The largest segment of in-home care is financed by insurance or by private payment. Instead of being limited to medical needs, these services tend to focus on personal care, companionship and assistance with the activities of daily living. They are usually very much about keeping individuals safe and independent at home. Services are typically — but not always — provided by licensed home care agencies. If an individual’s resources or insurance are not sufficient to cover the costs of this type of care, Medicaid can; however Medicaid will pay only for licensed services. Two specialized home care programs are available under Medicaid:

  • The Lombardi Program (Nursing Home without Walls)
  • Consumer-Directed Home Care
  • Managed Long Term Care

The Lombardi Program (Nursing Home without Walls/NHWW)

Individuals who need complex home care equivalent to the care provided in a nursing home will find it in New York’s unique Nursing Home Without Walls Program, also known as Lombardi Services. The program provides basic home health care for approximately 20 hours per week in addition to ancillary and comprehensive services such as skilled nursing, physical and rehabilitative therapy, transportation to medical appointments, nutrition counseling, home adaptations and equipment, and other specialized support, activities and options. Certified Home Health Agencies (CHAA’s) manage these Lombardi programs.

Consumer-Directed Medicaid Home Care

People living with disabilities and their families have long advocated for greater autonomy. In response to this, Medicaid permits capable recipients to recruit and hire their own home care workers as part of a program called Consumer Directed Home Care Program (CDP). Under CDP, the hired worker must have the legal right to work in the United States, have the proper training and certifications, be in good health, and accept the pay scale offered by the Medicaid agency. This is a joint effort between the Medicaid agency, which provides funding, and the Medicaid recipient, who provides administration — including recruiting, hiring and replacing home care workers, in addition to submitting weekly time sheets. CDP provides both flexibility and autonomy for persons with disabilities and their families and caregivers. More information on CDP can be found at http://www.health.state.ny.us/health_care /medicaid/program/longterm/cdpap.htm

Managed Long Term Care Home Care

As part of the New York State Medicaid Redesign Program initiated in 2012, Personal Care Services at home will no longer be managed by the individual’s local service district, such as Human Resources Administration in New York City, or county based, Department of Health offices.