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Spring Caregiving

Spring is a season of renewal for most of us. But for some whose time and attention is focused on the needs of an increasingly frail older person in the family, it can be harder to appreciate the sight of robins and the fragrant blossoms which they foreshadow.
Long-term care is not a seasonal activity. The chores of caregiving cannot always be scheduled as routinely as decorating for the holidays or mulching the lawn. Sometimes caregiving chores can be as unwelcome as an April snowstorm on the day of a special event which has been anticipated for months.
Caregiving can lead to burnout, even when the person receiving the care is a much loved spouse or parent. It can be hard to know what to hope for when each month, dementia seems to bring more challenging issues. The cost and intrusion of bringing a stranger into the home to provide occasional relief from caregiving chores can be a barrier that some families are unable or unwilling to accept. “I’m not ready yet” can be a barrier to the acceptance of help to avoid the danger of a foreseeable crisis.
For some families, hospitalization can be a gateway into the long-term care system. After a person spends two midnights in a hospital, unless the patient has been issued a Medicaid Outpatient Observation Notice (MOON) which says otherwise, it should be presumed that the patient will have Medicare Part A eligibility to receive at least 20, and up to 100 days of inpatient rehabilitation in a facility upon discharge from the hospital. If the rehabilitation facility also has long-term care beds and accepts Medicaid as a source of payment, the patient may not need to move again if, at the end of rehabilitation, it would be unsafe to return the patient to the home environment.
The reality that hospitalization can be a gateway to a solution is ironic. One of our previous clients, who was caring for her husband with advancing Alzheimer’s disease, observed that “something is wrong when it seems that I need to hope that my husband falls down the steps so we can get help with his care.” Fortunately, there are other options.
Sometimes a strong desire to keep a loved one at home remains, but burnout and other risk factors may be putting the health of the caregiving spouse at risk. The fear of what could happen in a nursing home can prevent a family from embracing that as an acceptable alternative. A program exists that can be a solution for many families.
SpiriTrust Lutheran LIFE operates the Living Independence For the Elderly (LIFE) Program for residents in Cumberland and parts of Perry County ( Eligible participants can be transported during the day to a facility on Good Hope Road in Hampden Township where they receive medical attention, assistance with personal needs, and socialization activities from one to five days per week. It is helpful if participants have a caregiver who can provide a safe environment at the home, where participants remain when not participating in the program. Other counties offer the federally funded LIFE Program through different providers.
On the surface, it might seem that a participant’s household does not meet the LIFE eligibility criteria. In many circumstances however, and especially when the participant’s income is below $2,300 per month, we have been able to guide applicants through a restructuring of their resources so that the eligibility requirements can be met legally without jeopardizing the financial well-being of the other spouse.
LIFE has been a good option for a number of our clients, despite reservations about giving up their own doctors, which is required since the program serves as both the primary medical and insurance contact. Another challenge for families may be the provision of 24/7 supervision that their loved one requires when not actively participating in LIFE’s weekday-only daytime services.
If the LIFE Program is not a good fit, and there is unwillingness to make a definite commitment to nursing home placement, respite care can be a good transitional option. Respite care is designed as short-term care in a facility, perhaps for a period of weeks, which can give a caregiver a chance to take a vacation or otherwise get a break. On several occasions, our clients’ respite care has evolved into a permanent solution because the person receiving the care has adjusted very well to residency in the nursing home.
Respite care is not paid by Medicare. The cost of private pay can be an obstacle for some, but the cost is less than 24/7 private home care. In many cases, Medicaid can be obtained after a couple of months. This reduces the cost so that adequate assets will remain for the well spouse to continue to live in the family home.
Our website has a lot of information about Medicaid, which remains the primary source of federal assistance to help middle-class Americans access and pay for long-term care. Most people are confused by the complex rules that guide how Medicaid can be accessed to pay for care in a skilled nursing facility, or for the LIFE Program. Many families are surprised to discover that Medicaid is not available to pay for care in a personal care or assisted living facility.

If you have questions about caring for a loved one, call our office for a free telephone consultation with our Care Coordinator.

By Dave Nesbit, Attorney