Children Caring for Aging Parents
Planning for decision making
Having a parent diagnosed with a long term illness such as dementia or Alzheimer's disease can be devastating, and can cause emotional upheaval and turmoil in a family. Many times, putting off thinking about long term care planning may be more comfortable. However, it is crucial to begin legal and health care planning now while Mom or Dad is still able to make these important life decisions. The "General Durable Power of Attorney" and "Appointment of Healthcare Representative" are legal documents which designate someone else to make financial and health care decisions for your parent when they are no longer able to make them on their own. If your parent no longer has the legal capacity to sign these documents, then a guardian can be appointed by the court to make financial and health care decisions. An elder law attorney can help ensure that important planning is not left to chance.
Finding Care for your Parent
If your parent is struggling to care for him or herself, there are a number of options available. While living at home or with family, the following services are available to help with care.
- Homemaker service - There are many options for homemaker services which can help your parent clean house, prepare meals, help with dressing, and drive them to appointments
- Transportation services
- Home delivered meals
- Adult Day Care
- Hospice Care - These services are paid for by Medicare for patients whose physician certifies that they have less than 12 months to live. Care can be in the home or in a facility.
If you live in Tippecanoe County or the surrounding counties and would like more information about these kinds of services and the providers that offer them, call the Area IV Agency on Aging at 765-447-7683, or visit the Web site at http://www.areaivagency.org/. If you live outside of Tippecanoe County, your local Agency on Aging will have similar information.
If your parent can no longer live at home, Assisted Living Facilities and Nursing Homes are an option. Area IV Agency on Aging
is a resource with information about local assisted living facilities and nursing homes. Medicare provides a website which allows you to compare facilities and the Indiana State Department of Health also has information available.
Paying for the Care your Parent Needs
Long term care can be expensive so it is important to know the payment options and make a plan ahead of time for payment of long term care. Having a well thought out plan prepared by an expert well help ensure that your parent receives the best care possible. The following may assist with payment of long term care expenses
- Your parent's assets such as IRA's. Additionally, a reverse mortgage on your parent's home may provide funding for care.
- Long Term Care Insurance
- Medicare – will only pay for a limited amount of care under special circumstances. The patient must have a 3-day hospital stay for acute medical needs. Medicare will cover the first 20 days completely and will provide additional coverage for up to 100 days provided that the patient’s medical needs continue to meet certain criteria (referred to as Skilled Level of Care).
- Medicare Supplement - if your parent meets Medicare’s criteria described above, your parent’s Medicare supplemental insurance policy may cover costs that Medicare does not cover
- Veteran’s Benefits - if your parent was a qualifying veteran or widow, your parent may qualify for the Veteran’s Aid and Attendance Pension.
- Medicaid – aid is based on asset and income limits
Getting Paid for your Services
Oftentimes while caring for your parent, you may receive money for your help based on an informal arrangement. This can cause problems when you apply for Medicaid for your parent because Medicaid has strict prohibitions on gifting. In the absence of a written contract, Medicaid considers the care you provide to your parent as voluntary. Any money your parent gives you for this help is considered a gift. You may run into additional complications during the Medicaid application process if you mixed finances by sharing a bank account or sharing expenses. Any of these activities may result in a period of ineligibility for Medicaid during which Medicaid will not pay for needed nursing home care.
If your parent wishes to give you money for the help you provide, the way to do this is to have a caregiver contract and an expense sharing agreement in place. A caregiver contract is a written agreement that states how you will be compensated for the care that you provide to your parent. An expense sharing agreement is a written agreement that states how expenses will be shared between you and your parent. This type of agreement is especially important if you are living in the same house. You must plan ahead, as Medicaid will require the contract be signed both before the care is given and before payments are made. The money that you receive from your parent should be reasonable for the services provided. Additionally, there are tax implications related to such an arrangement. An elder law attorney can help you put the contract in place so that you comply with both Medicaid's requirements and the applicable tax law.
Applying for Medicaid
If you are preparing to apply for Medicaid benefits for your parent in Indiana, the following government Web site provides information about how and where to apply, depending on your parent's county of residence: http://www.in.gov/fssa/dfr/2999.htm. During the Medicaid application process, you will need to gather and submit a number of documents to Medicaid. An elder law attorney can help you throughout the application process, including document preparation, application submission, and handling of appeals in the case of benefit denials. The following is a general list of documents that you will need when applying for Medicaid:
- Birth Certificate for parent in nursing home
- Social Security Card for parent in nursing home
- Medicare Card for parent in nursing home
- Marriage Certificate if your parent is married
- Health Insurance Card/Medicare Supplement Card for parent in nursing home
- Legal Documents your parent may have such as Power of Attorney or Trust
- Proof of Date of admission to hospital and nursing home
- Nursing Home Billing statements
- Proof of Social Security Income
- Health Insurance Premium Information
- Medicare Supplement Premium Information
- Medicare Part D Premium Information
- Proof of Veteran’s Benefits or Railroad Retirement Benefits
- Proof of Pension Income
- Income from rental or farm property and documentation of expenses
- Prepaid Funeral documentation and deed to burial plot
- Written verification of cash value of life insurance policies
- Bank Statements
- Real Property Deeds
- Registration or Title to any vehicle, boat, or RV
- Values of any stocks or bonds
- If one of your parent's is in a nursing home and the other is at home, you will need information concerning their housing expenses such as
- Assisted Living Payment/Rent/Mortgage Payment
- Property Tax statement
- Homeowners or Renters insurance statement
- Heating & electric bills
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