Personal Care Homes and Assisted Living Facilities
Many people use the terms “personal care homes” and “assisted living facilities” interchangeably for any residential care facility. However, in Pennsylvania the Department of Public Welfare licenses them as “Personal Care Homes.” On the website www.dpw.state.pa.us you can check for any violations found during DPW inspections.
These homes vary in size and services, but the core services are housing, meals, housekeeping, medication management, and help with personal care (i.e. dressing, bathing, and other activities of daily living). Some facilities have extensive activity programs, secure units for memory-impaired individuals, transportation for shopping and appointments, and on-site physical therapy.
If you are a client of Keystone Elder Law, the Elder Care Coordinator will assist you in locating a facility that meets your needs.
Financial Considerations
Basic costs can run from $1,500 to over $5,000 per month, depending on the size of the room and the particular services offered. Some Long-Term Care Insurance policies will cover a portion of these costs. Some veterans may be eligible for a supplemental monthly payment when in a personal care home. (If you are a client of Keystone Elder Law, the attorneys will help you apply for eligible VA benefits.) Some Personal Care Homes will accept a limited number of individuals who qualify for the state supplement under Supplemental Security Income (SSI). However, Medicare and Medicaid do not help pay for this level of care. Most facilities operate on a month-to-month basis and usually require a 30 notice when a resident decides to leave.
Other considerations : Try to get the best fit between the individual’s interests and needs and the facility’s characteristics.
If the resident has difficulty walking, try to get a room near the dining and activity centers, or look for a facility designed with short hallways.
If the resident likes to be involved, look closely at the activity program. Are there activities that interest the resident?
Check the dietary services. Are meals provided at times that fit the resident’s personal schedule? Can the dietary service meet the resident’s dietary restrictions, if there are any? Are the types of meals provided what the resident likes to eat?
How does a resident let someone at the facility know when he or she needs help? Some facilities have call bells in the rooms, some use emergency response transmitters, and some use both.
How convenient is the facility’s location for family and friends to visit? Are there private areas for family and friends to meet with the resident?
Are there physicians who come to the facility? Does the facility provide transportation to physician and other appointments?
If the resident has dementia, does the facility have a secured unit so the resident cannot wander outside the facility? Some facilities have a circular or square walkway so the residents never come to an end when walking.
Sometime in 2011 Pennsylvania plans to license a new level of care called “Assisted Living.” These facilities will provide more physical assistance for residents who need hands-on help but do not need to be in a nursing home. It is unknown at this point if Medicaid will help pay for this level of care. It will be important to remember there will be a difference between “Assisted Living Facilities” and “Personal Care Homes,” since many people presently use these terms interchangeably.
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REGISTER HERE for LONG-TERM CARE PLANNINGPower of Attorney
A Power of Attorney can be used to give another person the right to sell a car, home, or other property in the place of the maker of the Power of Attorney. A Power of Attorney might be used to allow another person to sign a contract for the maker of the Power of Attorney (the person who makes a power of attorney is called the “principal”). It can be used to give another person the authority to make health care decisions, do financial transactions, or sign legal documents that the principal cannot do for one reason or another. With few exceptions, Powers of Attorney can give others the right to do any legal acts that the makers of the Powers of Attorney could do them themselves. A General Power of Attorney gives the “power of attorney Agent” or simply “Agent” (the legal name of the person who is authorized to act for the principal) very broad powers to do almost every legal act that the principal can do. When Elder Law Attorneys draft general Powers of Attorney, they still list the types of things the Agent can do but these powers are very broad. People often do general Powers of Attorney to plan ahead for the day when they may not be able to take care of things themselves. By doing the General Power of Attorney, they designate someone who can do these things for them.
Normal Powers of Attorney terminate if and when the principal becomes incompetent. Yet many people do Powers of Attorney for the sole purpose of designating someone else to act for them if they cannot act for themselves. It is precisely when persons can no longer do for themselves that a Power of Attorney is most valuable. To remedy this inconsistency, the law created a Durable Power of Attorney that remains effective even if a person becomes incompetent. The only thing that distinguishes a Durable Power of Attorney from a regular Power of Attorney is special wording that states that the power survives the principal’s incapacity. Even a Durable Power of Attorney, however, may be terminated under certain circumstances if court proceedings are filed. Most Powers of Attorney done today are durable.
Yes. At the time the Power of Attorney is signed, the principal must be capable of understanding the document. Although a Power of Attorney is still valid if and when a person becomes incompetent, the principal must understand what he or she is signing at the moment of execution. That means a person can be suffering from dementia or Alzheimer’s Disease or be otherwise incompetent sometimes but as long as they have a lucid moment and are competent at the moment they sign the Power of Attorney, it is valid even if they do not remember signing it at a later date. At the time it is signed, the principal must know what the Power of Attorney does, whom they are giving the Power of Attorney to, and what property may be affected by the Power of Attorney.
Any competent person eighteen years of age and older can serve as an agent. Certain financial institutions can also serve. There is no course of education that agent must complete or any test that Agent must pass. Because a Power of Attorney is such a potentially powerful document, agents should be chosen for reliability and trustworthiness. In the wrong hands, a Power of Attorney can be a license to steal. It can be a big responsibility to serve as an agent.
For Medicaid
Medicare is health insurance and covers medical services such as physician appointments, therapy, blood tests, x rays, medical procedures and hospitalization. Medicare will sometime pay for rehabilitation in a long-term care facility for a period of 20 to 100 days, but not longer. In long-term care, Medicaid covers the cost of ongoing support services for daily functioning, such as room and board in a nursing home.
Medicaid is a federal program that is overseen by the Center for Medicare and Medicaid Services (CMS). In Pennsylvania, Medicaid is called Medical Assistance and is administered by the Department of Human Services (DHS).
In Pennsylvania, Medicaid funds are not available to pay for assisted living or personal care.
For Medicaid to pay for care in a nursing home, an individual recipient must be determined to need a nursing home level of care by a physician and the local Office of Aging. An individual whose income is not greater than three times the poverty level may keep up to $8,000 of total resources, but may otherwise keep only $2,400. The cash value of life insurance counts as a resource, but one car and a residential home does not count as a resource.
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Keystone Elder Law
At Keystone Elder Law, we believe that the physical, social, legal, and financial considerations of our clients all intertwine. We utilize an interdisciplinary approach to evaluate each area, which allows for the creation of a plan that addresses the concerns of the individual as a whole as well as the family. To this end, our model of practice includes a Care Coordinator (usually a nurse or social worker), whose expertise complements our team of attorneys.
When the road of life is smooth, decisions about legal and financial matters are easy to push aside for “a rainy day.” Planning ahead, however, will allow for more options as you view the map of where you’ve been and where you want to go. Don’t let a crisis limit your choices or derail your plans.
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