Please click on the link below for an informative checklist for patients and caregivers preparing to leave a hospital, nursing home or other health care setting.
Planning for Your Discharge Checklist
August 31, 2009
Little-Known Government Program Pays the Cost of Elder Care
WHAT IF 33% OF ALL SENIORS IN THIS COUNTRY could receive up to $1,949 a month in additional income from the government to help cover their elder care costs? THEY CAN!
Under the right circumstances, a little-known federal program will pay additional income to cover long term care costs for at least 1/3 of all US senior households -- that's how many war veterans or their surviving spouses there are in this country. But the provisions of this program are such a well-kept secret that only 4.7% of US seniors are actually receiving the benefit. The great news about this program is the Department of Veterans Affairs will pay you to hire your family, friends or just about anyone to take care of you (Caregiving spouses can't be paid under this program). The program is called "Veterans Pension."
Most people who have heard about Pension know that it will cover the costs of assisted living and, in some cases, cover nursing home costs as well. But the majority of those receiving long term care in this country are in their homes. Estimates are that approximately 70% to 80% of all long term care is being provided in the home. All of the information available about Pension overlooks the fact that this benefit can also be used to pay for home care.
It also comes as a surprise to most people that the Department of Veterans Affairs will allow veterans' households to include the annual cost of paying any person such as family members, friends or hired help for care when calculating the Pension benefit. This annual cost is deducted from household income and used to calculate a lower "countable income" which in turn enables families to receive this disability income from VA. Even though VA claims the benefit is for low income families, because of the special provision in the regulations -- allowing for deduction for care costs -- households earning between $3,000 to $6,000 a month or more can still qualify for Pension under the right conditions.
This extra income can be a welcome benefit for families struggling to provide eldercare for loved ones at home. Under the right circumstances, this annualized medical expense for the cost of family members, friends or any other person providing care, could create an additional household income of up to $1,056 a month for a single surviving spouse of a veteran, up to $1,644 a month for a single veteran or up to $1,949 a month for a couple.
If the disabled care recipient has been rated "housebound" or in need of "aid and attendance" by VA, all fees paid to an in-home attendant will be allowed as long as the attendant provides some medical or nursing services for the disabled person. The attendant does not have to be a licensed health professional. There is also no need to distinguish between medical and nonmedical services -- all are deductible.
For a disabled person who has been rated "in need of aid and attendance" or "housebound", a family member will be considered an in-home attendant, but that family member has to be paid for services duly rendered. There is potential for fraud here where a family member may move into the home and ostensibly receive payment as a caregiver but not actually provide the level of care paid for. Documentation for this care must be provided to VA, and it is reasonable for VA to question whether the services being purchased from a family member living in the household are legitimate. Such arrangements should be extensively documented and completely arm's-length.
The care arrangements and payment for home care must be made prior to application and there must be evidence that this care is needed on an ongoing and regular basis. We recommend a formal care contract and weekly invoice billing for services. Money must exchange hands and federal law requires employment taxes must be withheld and there must be evidence of this. All of this documentation must be provided as proof to VA when making application for the pension benefit. Costs for these services must be unreimbursed; meaning these costs are not paid by insurance, by contributions from the family or from other sources. VA will allow, however, family caregivers being paid by their loved ones, to turn around and pay the household bills for their loved ones to help defray the cost of the care.
Due to the need for a rating, documentation for annualizing care costs and the extensive proof needed to show the caregiver is indeed an employee of the care recipient, most people should not try this on their own. An expert in this area should be sought to help with the application in order to avoid lengthy delays in awarding a benefit or a possible denial of benefits. For a list of individuals or companies in your area who understand how to get this benefit go tohttp://www.longtermcarelink.net/ref_veterans_consultants.htm
Under the right circumstances, a little-known federal program will pay additional income to cover long term care costs for at least 1/3 of all US senior households -- that's how many war veterans or their surviving spouses there are in this country. But the provisions of this program are such a well-kept secret that only 4.7% of US seniors are actually receiving the benefit. The great news about this program is the Department of Veterans Affairs will pay you to hire your family, friends or just about anyone to take care of you (Caregiving spouses can't be paid under this program). The program is called "Veterans Pension."
Most people who have heard about Pension know that it will cover the costs of assisted living and, in some cases, cover nursing home costs as well. But the majority of those receiving long term care in this country are in their homes. Estimates are that approximately 70% to 80% of all long term care is being provided in the home. All of the information available about Pension overlooks the fact that this benefit can also be used to pay for home care.
It also comes as a surprise to most people that the Department of Veterans Affairs will allow veterans' households to include the annual cost of paying any person such as family members, friends or hired help for care when calculating the Pension benefit. This annual cost is deducted from household income and used to calculate a lower "countable income" which in turn enables families to receive this disability income from VA. Even though VA claims the benefit is for low income families, because of the special provision in the regulations -- allowing for deduction for care costs -- households earning between $3,000 to $6,000 a month or more can still qualify for Pension under the right conditions.
This extra income can be a welcome benefit for families struggling to provide eldercare for loved ones at home. Under the right circumstances, this annualized medical expense for the cost of family members, friends or any other person providing care, could create an additional household income of up to $1,056 a month for a single surviving spouse of a veteran, up to $1,644 a month for a single veteran or up to $1,949 a month for a couple.
If the disabled care recipient has been rated "housebound" or in need of "aid and attendance" by VA, all fees paid to an in-home attendant will be allowed as long as the attendant provides some medical or nursing services for the disabled person. The attendant does not have to be a licensed health professional. There is also no need to distinguish between medical and nonmedical services -- all are deductible.
For a disabled person who has been rated "in need of aid and attendance" or "housebound", a family member will be considered an in-home attendant, but that family member has to be paid for services duly rendered. There is potential for fraud here where a family member may move into the home and ostensibly receive payment as a caregiver but not actually provide the level of care paid for. Documentation for this care must be provided to VA, and it is reasonable for VA to question whether the services being purchased from a family member living in the household are legitimate. Such arrangements should be extensively documented and completely arm's-length.
The care arrangements and payment for home care must be made prior to application and there must be evidence that this care is needed on an ongoing and regular basis. We recommend a formal care contract and weekly invoice billing for services. Money must exchange hands and federal law requires employment taxes must be withheld and there must be evidence of this. All of this documentation must be provided as proof to VA when making application for the pension benefit. Costs for these services must be unreimbursed; meaning these costs are not paid by insurance, by contributions from the family or from other sources. VA will allow, however, family caregivers being paid by their loved ones, to turn around and pay the household bills for their loved ones to help defray the cost of the care.
Due to the need for a rating, documentation for annualizing care costs and the extensive proof needed to show the caregiver is indeed an employee of the care recipient, most people should not try this on their own. An expert in this area should be sought to help with the application in order to avoid lengthy delays in awarding a benefit or a possible denial of benefits. For a list of individuals or companies in your area who understand how to get this benefit go tohttp://www.longtermcarelink.net/ref_veterans_consultants.htm
Cost Saving Examples After Hiring a Professional Geriatric Care Manager
A professional geriatric care manager (PGCM) can help families realize cost savings, but the biggest advantage is the emotional peace of mind knowing that a relative or loved one is being cared for with the most appropriate level of care as recommended by the PGCM.
Regarding the average savings from hiring a GCM, The National Association of Professional Geriatric Care Managers (NAPGCM) does not generate projectable data across the country. Every case is unique. What we can tell you are areas that have resulted in savings when a professional geriatric care manager is in the picture. Here are some of those that we often see:
1. Saving in care costs – Recommending live-in care when appropriate in place of (more expensive) shift care. Recommending free or low-cost products and services that may be available in local communities. Understanding today’s medical system can save clients money while ensuring the appropriate level of care.
2. Making the most of insurance – Ensuring that secondary insurance had been given and billed for medical bills coming to a senior's home. Avoiding paying unnecessary bills. Realizing benefits from public programs including those from Veterans Administration (VA) benefits and from programs like Medicare and Medicaid. Helping clients enroll in the most appropriate Medicare Part D (pharmacy benefit) plans for their state (and there are many in each state from which to choose).
3. Avoiding expensive duplication – Ensuring that seniors aren't paying for duplicative insurance, aren't donating repetitively to a charity (when the senior forgets they just donated last week or last month), or aren't buying duplicative clothing or food when the senior forgets what they already have in the home.
4. Saving in travel expenses – Supervising care including medical appointments, operations of in home staff can postpone expensive travel to a relative.
5. Avoiding lost wages – Monitoring caregiving. Some adult children take leave from work after vacations have been exhausted, to check on Mom or Dad. A PGCM can be the person on site to monitor the caregiving level.
6. Saving in household expenses – Identifying cost saving programs. Utility companies or other providers offer discount programs for seniors. PGCMs are aware of these programs and can recommend and sign up these services for the loved one.
7. Making better financial decisions – Encouraging clients to speak with financial planners about whether annuities are really good investment choices, especially when clients in their 80's can't access their funds without large withdrawal penalties. Curtailing compulsive spending from shopping on line or on TV.
8. Discovering assets the loved one might not have realized existed in the home. For instance, when a house is cleaned and put in order, often hidden money and valuables are found.
9. Savings in time and efficiency – While information is available (and NAPGCM recommends that consumers educate themselves), a PGCM is experienced in the wide range of resources available and can do the job in half (or less than half) the time.
Other Scenarios
1. Correct coding/insurance – When an elder had a terrible accident, was in a coma, hospitalized and then transferred to a rehabilitation hospital, her elder husband was overwhelmed with her care. She was transferred to a skilled nursing facility (SNF) near only child. The PGCM was hired when the decision was made to transfer her for long term care near her husband. Upon admission to the SNF, the son had signed a private pay agreement for following her Medicare days. He was eventually presented with a bill for $15,000 and the promise of future bills. After the PGCM discovered they had counted her rehab hospital days as SNF days (even though they had, of course, received referral from hospital), she urged the son not to pay the bill, which was clearly in error. Though receiving a couple of pretty threatening calls from the SNF wondering why I was giving such advice, the PGCM was right and the family did not pay. Also, this was accomplished without an attorney.
2. Telling families of the benefits from the VA system. Saved one son $1,600 per month (he was paying out of this money before VA). Also, VA provides free hearing aids and other services to veterans.
3. Recommending most cost effective level of care. Spouse who had her husband in a nursing home plus 24-7 care. Moved him to a small residential family home owned by a nurse. Cut the costs to the family in half. Wife didn’t know he could be at a lower level of care.
4. Helping families chose the most cost effective care plan (caregivers, agencies, care management)
5. Helping families advocate for lost dentures and/or glasses in skilled nursing facilities. Ombudsman comes into to play and it is the facilities responsibility to replace them.
6. Helping families with supplies – like incontinent supplies – finding sources on-line at less the drug store costs with free delivery.
7. Advocating for more time in acute care or skilled care by pointing out new diagnosis that give clients more days of care.
8. Telling families about free items – like hearing enhanced phones or other communication devices for the telephone company.
9. Helping spouse understand that Medicaid will pay for skilled nursing – they don’t have to sell the farm. But, they do need to qualify. Advising working with an Elder Law attorney to help.
10. Telling families about free services that are location specific. We have a hospital that has a volunteer helping/companion service and another small city that provides free shoppers for seniors.
11. Understanding that “Meals on Wheels” can often be free or donation only.
12. Getting clients “transportation” systems that are either a van with low costs or taxi scripts.
13. Signing clients up for low cost rates at the gas & electric company.
The rates are typically $300 - $800 for an initial assessment and $80 - $200 per hour depending on the region.
To find a PGCM in your area, visit www.caremanager.org for a searchable database by zip code or state.
Regarding the average savings from hiring a GCM, The National Association of Professional Geriatric Care Managers (NAPGCM) does not generate projectable data across the country. Every case is unique. What we can tell you are areas that have resulted in savings when a professional geriatric care manager is in the picture. Here are some of those that we often see:
1. Saving in care costs – Recommending live-in care when appropriate in place of (more expensive) shift care. Recommending free or low-cost products and services that may be available in local communities. Understanding today’s medical system can save clients money while ensuring the appropriate level of care.
2. Making the most of insurance – Ensuring that secondary insurance had been given and billed for medical bills coming to a senior's home. Avoiding paying unnecessary bills. Realizing benefits from public programs including those from Veterans Administration (VA) benefits and from programs like Medicare and Medicaid. Helping clients enroll in the most appropriate Medicare Part D (pharmacy benefit) plans for their state (and there are many in each state from which to choose).
3. Avoiding expensive duplication – Ensuring that seniors aren't paying for duplicative insurance, aren't donating repetitively to a charity (when the senior forgets they just donated last week or last month), or aren't buying duplicative clothing or food when the senior forgets what they already have in the home.
4. Saving in travel expenses – Supervising care including medical appointments, operations of in home staff can postpone expensive travel to a relative.
5. Avoiding lost wages – Monitoring caregiving. Some adult children take leave from work after vacations have been exhausted, to check on Mom or Dad. A PGCM can be the person on site to monitor the caregiving level.
6. Saving in household expenses – Identifying cost saving programs. Utility companies or other providers offer discount programs for seniors. PGCMs are aware of these programs and can recommend and sign up these services for the loved one.
7. Making better financial decisions – Encouraging clients to speak with financial planners about whether annuities are really good investment choices, especially when clients in their 80's can't access their funds without large withdrawal penalties. Curtailing compulsive spending from shopping on line or on TV.
8. Discovering assets the loved one might not have realized existed in the home. For instance, when a house is cleaned and put in order, often hidden money and valuables are found.
9. Savings in time and efficiency – While information is available (and NAPGCM recommends that consumers educate themselves), a PGCM is experienced in the wide range of resources available and can do the job in half (or less than half) the time.
Other Scenarios
1. Correct coding/insurance – When an elder had a terrible accident, was in a coma, hospitalized and then transferred to a rehabilitation hospital, her elder husband was overwhelmed with her care. She was transferred to a skilled nursing facility (SNF) near only child. The PGCM was hired when the decision was made to transfer her for long term care near her husband. Upon admission to the SNF, the son had signed a private pay agreement for following her Medicare days. He was eventually presented with a bill for $15,000 and the promise of future bills. After the PGCM discovered they had counted her rehab hospital days as SNF days (even though they had, of course, received referral from hospital), she urged the son not to pay the bill, which was clearly in error. Though receiving a couple of pretty threatening calls from the SNF wondering why I was giving such advice, the PGCM was right and the family did not pay. Also, this was accomplished without an attorney.
2. Telling families of the benefits from the VA system. Saved one son $1,600 per month (he was paying out of this money before VA). Also, VA provides free hearing aids and other services to veterans.
3. Recommending most cost effective level of care. Spouse who had her husband in a nursing home plus 24-7 care. Moved him to a small residential family home owned by a nurse. Cut the costs to the family in half. Wife didn’t know he could be at a lower level of care.
4. Helping families chose the most cost effective care plan (caregivers, agencies, care management)
5. Helping families advocate for lost dentures and/or glasses in skilled nursing facilities. Ombudsman comes into to play and it is the facilities responsibility to replace them.
6. Helping families with supplies – like incontinent supplies – finding sources on-line at less the drug store costs with free delivery.
7. Advocating for more time in acute care or skilled care by pointing out new diagnosis that give clients more days of care.
8. Telling families about free items – like hearing enhanced phones or other communication devices for the telephone company.
9. Helping spouse understand that Medicaid will pay for skilled nursing – they don’t have to sell the farm. But, they do need to qualify. Advising working with an Elder Law attorney to help.
10. Telling families about free services that are location specific. We have a hospital that has a volunteer helping/companion service and another small city that provides free shoppers for seniors.
11. Understanding that “Meals on Wheels” can often be free or donation only.
12. Getting clients “transportation” systems that are either a van with low costs or taxi scripts.
13. Signing clients up for low cost rates at the gas & electric company.
The rates are typically $300 - $800 for an initial assessment and $80 - $200 per hour depending on the region.
To find a PGCM in your area, visit www.caremanager.org for a searchable database by zip code or state.
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