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At Home, Nursing Home, or End of Life Care: Exploring Your Love One’s Options

June 4, 2019 by Greg Port, J.D., M.B.A.


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Your Options for Elder Care: At Home, Nursing Homes & End of Life Care

If you’re overwhelmed by the many different options available for your loved one’s care in their golden years, you’re not alone. There are a dizzying array of possibilities, ranging from skilled care in a professional nursing facility, care in your loved one’s home, and, in cases of serious illness, end of life care might be a necessity.

Read on to understand the differences between these types of care that are available to your loved one.

Caring for Elderly Relatives at Home

If your loved one is in relatively good health and isn’t interested in (or can’t afford) moving to an assisted living community or a nursing home, caring for that elderly relative at home is certainly a viable option.

Can you get paid for taking care of an elderly relative?

Yes, there are Medicaid programs that enable family members to care for their aging relatives. Home and Community Based Services, or HCBS, Waivers (also known as 1915 Waivers) enable states to pay for individual care and support services outside of nursing homes.

An Elder Care Attorney can walk you through the steps required to ensure that all of the paperwork is properly filled out so that your elderly relative gets the care they need and you’re reimbursed appropriately for providing that care.

How do you hire a home care provider?

Of course, you don’t want just anyone to care for your loved one. Before you set out to hire a home caregiver, be sure to consult your loved one’s physician to determine the level of services that are required. From there, write out a detailed job description, listing all of the duties you expect the caregiver to provide, including bathing, dressing, feeding, transportation, household chores, physical therapy, and more.

You might consider going through an agency to find a qualified home care provider. They’ll screen candidates, handle paperwork, provide backup should your caregiver be unable to be there, and take care of insurance. If you decide to do a search on your own, be prepared to screen applicants carefully and take on the burden of employment taxes and unemployment insurance.

For in-depth information about finding a home care provider, visit the National Association for Home Care & Hospice (NAHC).

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Nursing Homes

Sometimes, your loved one requires around-the-clock care that can best be provided by a nursing home. Sounds expensive? You’re not wrong. But there are ways to get your loved one the care they need.

Does Medicare pay for nursing home care for the elderly?

In a word, yes. But there are caveats. Medicare Part A will cover up to 100 days of “skilled nursing” care for every incident of illness. However, there are very strict requirements that must be met if you want your visit to be covered. According to Elder Law Answers, these include:

  • The Medicare recipient must enter the nursing home no more than 30 days after a hospital stay (meaning admission as an inpatient; "observation status" does not count) that itself lasted for at least three days (not counting the day of discharge).
  • The care provided in the nursing home must be for the same condition that caused the hospitalization (or a condition medically related to it).
  • The patient must receive a "skilled" level of care in the nursing facility that cannot be provided at home or on an outpatient basis. In order to be considered "skilled," nursing care must be ordered by a physician and delivered by, or under the supervision of, a professional such as a physical therapist, registered nurse or licensed practical nurse. Moreover, such care must be delivered on a daily basis. (Few nursing home residents receive this level of care.)

As soon as the patient is deemed healthy enough to discontinue skilled care, that coverage ends. Also, it’s important to note that after day 20 of the patient’s nursing home stay, care is no longer covered at 100%. For days 21-100, Medicare covers all costs above $99/day, which must be paid out of pocket, if your loved one doesn’t have Medigap insurance to pick up the cost. And, of course, after day 100, Medicare will stop paying altogether.  

What are the costs of nursing homes?

Nursing homes can vary significantly in cost, depending on many different factors. Is your loved one in a private room? A semi-private room? What are the amenities like? Does your loved one require physical therapy? Memory care? The costs can mount up.

The average monthly cost for a semi-private room in a nursing home in Ohio is $7,118; a private room is, on average, $7,908. As stated above, if the patient’s stay is temporary, you can get assistance from Medicare, but if you and your loved one have decided that a nursing home is the best option for long-term care, the costs can add up.

Talk to an experienced Elder Care Attorney to discuss your best options and get the guidance you need to make the decision that’s right for your loved one.

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Hospice and End of Life Care

What is end of life planning?

Life Care Planning is an extension to Elder Care Law which seeks to plan for the medical side as well as the legal side of things.  While traditional elder care law focuses primarily on preserving your loved one’s assets to pass on to the next generation, Life Care Planning uses the loved one’s assets to preserve their quality of life and independence for as long as possible.

Often, a balance of both preserving quality of life and leaving assets to the next generation is what most of our clients opt for.

Working with an interdisciplinary team, a Life Care Planning law firm will work to identify your loved one’s needs, both presently and in the future. They’ll take that information and use it to locate high-quality, appropriate care.

When you’ve got a plan in place, there won’t be any need to make hasty, potentially detrimental decisions simply because you’re in the midst of a crisis. Instead, these choices will be made based on your loved one’s needs and desires.

The aspects of traditional elder law are a vital component of Life Care Planning. Services such as asset preservation, estate planning, and public benefits qualification will all be handled by your Life Care Planning team, in addition to care coordination, financial and health care decision-making, family education and support, and more.

What is a hospice plan of care?

A hospice plan of care (POC) is developed from the initial and comprehensive assessments made by medical professionals. It acts as a sort of road map for the patient’s care. The plan should encompass all of the services that are required for the management of the patient’s terminal illness as well as any additional related conditions.

According to the Medicare Benefit Policy Manual, the POC:

  • Must be reviewed and updated by the IDG at intervals specified in the POC, but no less frequently than every 15 calendar days.
  • Should continually be assessed to ensure that the care the beneficiary receives meets their conditions and needs.
  • When revised, must include information from the patient's updated comprehensive assessment and must note the patient's progress toward outcomes and goals specified in the POC.
  • Should be updated if the beneficiary's condition improves or deteriorates, and when the level of care changes.
  • Will include an assessment of the individual's needs and identification of the services, including the management of discomfort and symptom relief.
  • Must state in detail the scope and frequency of services needed to meet the beneficiary's and family's needs.
  • Acts as a road map for the IDG to provide consistent, cohesive care, and will support the medical necessity of hospice care.

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What about palliative care?

Palliative care is appropriate for patients living with a chronic, serious illness. These include dementia, Parkinson’s disease, heart failure, cancer, chronic obstructive pulmonary disease, and more. Ideally, palliative care should be implemented upon diagnosis, but it can be helpful at any point in the patient’s illness.

Palliative care doesn’t just improve the patient’s quality of life by helping them manage symptoms. It also helps patients and their loved ones understand the choices available to them for medical treatment.

In addition to handling the patient’s medical care, it’s also important to ensure that their legal documents are in order. If you’re not sure where to start, you can consult an experienced Elder Care Law attorney who can give you the guidance you need.

How To Prepare When a Loved One is in Hospice or Palliative Care

How to Create an End of Life Care Plan

There are three primary tenants of Life Care Planning; these include:

Ensure appropriate care— Whether it’s at their home or in a residential facility, it’s important that your loved one is getting the care they need to maintain their desired quality of life.

Handle cost of care— If you’ve looked into paying for long-term care for a loved one, you probably know that the cost is not insignificant. Life Care Planning will help you find both public and private sources to pay for your loved one’s long-term care, so you won’t be overwhelmed by the ever-growing cost.

Preserving peace of mind— Ultimately, you want to know that your aging loved one is well cared for and happy. Having a plan in place to ensure that they’re getting the care they need will offer peace of mind like nothing else.

A qualified Life Care Planning firm will utilize a model called the Elder Care Continuum that will enable families to better understand the inevitable progression of aging and the many ways that it impacts their loved ones. As they age, people find that changes occur across the board, including in their health, housing, general mobility, and financial resources.

The Elder Care Continuum will help your team determine where in the timeline your loved currently falls and it acts as a visual aid for you to see what the future might hold for you and your loved one.

From there, you can discuss the gaps that your loved one’s current care plan has and determine how you can fill those gaps.

Then, you will work with the team to create a customized Life Care Plan that will define, organize, prioritize, and mobilize every part of your loved one’s care. Having a strategy in place will ensure that their quality of life will not suffer as time passes.

It can be stressful to plan for your loved one’s future. An elder care lawyer can give you the peace of mind you need as you navigate the challenges that arise. Click here to schedule a free, no-obligation consultation with the experts at Port Legal today.

Our consultations are completely free of charge and intended to equip you to make the best decision.


Topics: Elder Care

Greg Port, J.D., M.B.A.

Written by Greg Port, J.D., M.B.A.

Port Legal founding attorney, Gregory Port has over 30 years experience. He has provided strategic corporate law representation in Central Ohio to clients since 1990. Gregory Port is a lawyer actively practicing in the areas of probate, estate planning, and real estate. His experience and core values are the cornerstones of Port Legal as a specialized advocate for your interests.