What Happens When There’s No Money Left to Pay for Care?
There are Options
By Alexander Nury, Co-Author of Survival Guide to Caring for Aging Parents
You have an elderly parent who needs more long-term care than you can provide. You find out that the required costs are enormous when you’re trying to cover home help or a facility for a parent. Thirty dollars an hour for a caretaker adds up fast, not to mention assisted living that can run from $5,000 to $10,000 a month. Most families just do not have that sitting around. So, what can you do when the money runs out or never quite existed in the first place?
I found this out the hard way, with my mom’s first foray into a skilled nursing facility, requiring a caregiver 7 days a week.
Well, there are some choices and resources that you can tap into, but they are scattered across different programs and agencies. Navigating them is daunting, and they are by no means a panacea. There are tradeoffs, so let’s explore.
Medicaid (Not Medicare)
Medicare will not cover ongoing, long-term care like this. It’s primarily for people 65 and over, and will only cover a short rehab stay after hospitalization; it won’t cover months and years of long-term care. People mix it up with Medicare all the time, but Medicaid is what actually steps in for nursing homes or home services in a lot of states through waiver programs. However, you usually need to have low assets, or you may need to work out a spend down with someone who knows the rules. The rules change by state, so it is worth looking into it, even if it feels like you earn too much or your parent has assets.
Check with local agencies
One thing that helped me sort some of this was calling the local Area Agency on Aging. They point out sliding-scale stuff, Meals on Wheels, adult day care, and other local things that don’t show up in a quick search. The number is easy to find through the eldercare locator or you can dial 800-677-1116. Many of these services are free or sliding-scale, based on what you can afford.
PACE Programs
If both Medicare and Medicaid apply for your parent, there are also PACE programs in some places. PACE wraps medical visits, rides, meals, and support together, often with little or no extra cost. Not everywhere has it available, though.
Veteran’s Benefits
If your parent served in the military, don’t overlook Veteran’s benefits. The VA’s Aid and Attendance program can provide a monthly cash payment that can help with care costs, and it is separate from the regular pension. A county veterans’ officer can walk through it for no charge. Just reach out to your local County Veterans office and talk to an officer, free of charge.
Some States (like California) will Actually Pay You to be a caregiver
Some states enable family caregivers to get paid through Medicaid programs. It is not a full salary, but it recognizes the work that’s already happening and is worth looking into. Consult with your local Area Agency or State Medicaid office.
Nonprofit and Disease-Specific Grants
Groups tied to certain illnesses sometimes may have small specific grants for caregiving, equipment, and supplies. Places like the Alzheimer’s Association or similar agencies for Parkinson’s or cancer can be called even if the amount is not huge.
Hospice, If It Applies
Hospice (or end-of-life care) may apply later, and Medicare will cover most of it no matter the income. That includes the nurse visits and comfort supplies once the time feels right. These conversations are difficult to have, but financially, it can make a difference for families in this stage of life.
Bottom Line
No one program solves every need. Families usually end up mixing a waiver here with a local grant or benefit there. The real issue seems to be waiting too long before asking around. The pieces are out there, but you have to hunt for them or get someone who already knows the possibilities. Whatever you decide, start as soon as you can. Finding, applying, and getting approval for these benefits takes time. In the meantime, the bills keep coming.