Care Alternatives

Studies suggest that Americans age 65 and older are less likely to be chronically disabled or living in a nursing home today than seniors of the same age were two decades ago. Still, there may come a time when you can no longer manage on your own. You may simply need help with daily grooming, bathing, preparing meals—or just getting around. Or, you may need round-the-clock care in a nursing home. There are options available.

How do I find help for my elderly mother who wants to continue living in her own home?

First, assess your mother's particular needs. She may qualify for in-home services through Arizona Health Care Cost Containment System (AHCCCS), Arizona Long Term Care (ALTCS) if she has very limited resources. ALTCS is a Medicaid program that pays for in-home assistance in order to maintain the individual in an independent setting as long as possible.

If she does not qualify for ALTCS and simply needs assistance with daily tasks, you could hire a caregiver through a home care agency or home care referral company. Or, you could hire someone on your own. However, if you are the caregiver's direct employer, you will be responsible for paying employment taxes and workers' compensation.

But whether you hire someone through an agency or on your own, be extremely cautious, seek referrals and ask a lot of questions. Such caregivers are not regulated by anyone.

Caregivers who provide medical care, however, must be licensed or certified. You can hire such caregivers through a licensed home health care agency. Home health care agencies, certified nurse assistants, registered nurses, nurse practitioners and licensed vocational nurses all must be licensed or certified by the state. The Department of Health Services can verify a caregiver's license or certificate or refer you to the appropriate agency.

Will Medicare cover the costs of a caregiver?

It depends. If a doctor prescribes medically necessary home health care for a homebound senior, Medicare will cover some of the costs. (You must use a Medicare-approved home health agency.) Medicare will not, however, pay for a caregiver who provides non-medical assistance. This is one reason why some seniors and their loved ones invest in long-term care insurance. For a listing of Medicare-approved home health agencies, you can contact the Medicare Hotline at (800) 633-4227 or TTY/TDD (877) 486-2048 or visit the Medicare website for more information.

What other assistance is available for those who are elderly and homebound?

You can get hot meals delivered to your home through Meals on Wheels. And to give caregivers a break, respite care is available. Check into Adult Day Care Centers and Adult Day Care Health Centers (ADHC). In addition, community care facilities may fill unused beds on a short-term basis to provide respite care for seniors who need 24-hour supervision.

Where can I find information on nursing homes?

Your local Area Agency on Aging is a good place to start. You might also check the Arizona Department of Economic Security's Web site. The Arizona Department of Health Services and AARP provide information as well. Or you could contact your local long-term care Ombudsman.

To verify the license of a nursing home or other skilled long-term care facility, call the Department of Health Services licensing and certification unit at (602) 364-2690.

Will Medicare pay some of my mother's nursing home expenses?

Possibly, but not for longer than 100 days and only if your mother requires skilled care. In addition, Medicare would only cover part of the costs. After the first 20 days, your mother would have to make a co-payment of $119 a day. If she qualifies for ALTCS, however, more assistance may be available. Generally, ALTCS, covers longer stays in a nursing home. For more information, you could contact Medicare or your local State Health Insurance and Assistance Program (SHIP) advisor.

If my elderly mother gives away her assets, will ALTCS, pay for a nursing home?

Creating sudden poverty will not help your mother qualify for ALTCS. In determining eligibility, ALTCS reviews each individual's past finances to see what, if any, assets have been given away. (Historically, ALTCS, looked back over a 36-month period. However, in light of recent changes in the law, ALTCS will soon look back even further.) “Spending down” to avoid nursing home costs could drastically affect an individual's eligibility for ALTCS. It may, however, be worth checking further into ALTCS eligibility criteria. If your mother has few assets, she may already qualify for at least partial coverage and not realize it. Also, keep in mind that different financial requirements apply to couples when, for example, one spouse is able to continue living at home. Check with a qualified advisor before making any decisions.

Is there any assistance available if I take time off work to care for my ailing mother?

You may qualify for the Family Medical Leave Act (FMLA) depending on your employer and the severity of your mother's health condition.

Am I legally required to support my penniless, bedridden father?

No, unless you have a legal obligation to do so such as through guardianship, power of attorney, or a De Facto Guardian.

What is hospice care?

Hospice care is a program—usually a mix of physical, emotional, spiritual and practical care— for the terminally ill. It may take place in a patient's home or in a specially designed facility. A doctor's sign-off is required for participation. And payment is often on a sliding scale based on income. Medicare covers hospice care as do other insurance programs. For more information visit the Arizona Hospice and Palliative Care Organization on-line or call (602) 712-9822

On 10/4/06
john said
No one can grow old alone