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May 26, 2005
ASSISTED LIVING ON A BUDGET
Today I am writing to you from San Francisco where I am attending the 2005 Elder Law Symposium sponsored by the National Academy of Elder Law Attorneys. Many of the seminars that I have attended dealt with recent and proposed changes to both Medicare and Medicaid on a national basis. In the coming weeks I’ll be telling you about what they are and how they affect you.
For some seniors, the maintenance and upkeep of living at home can be overwhelming. An apartment or condominium is an alternative, but if you need some assistance, and the thought of simply sharing a meal with friends, instead of cooking sounds good to you, you might consider assisted living. The one downside of assisted living is the cost. For a single person, the monthly cost of an assisted living unit is about $2,500 per month. What if you don’t have enough income to afford it? There is something called the Group Adult Foster Care (GAFC) program that can reduce the cost by more than 50%!
Most assisted living facilities have a limited number of GAFC rooms. For people able to get one of these rooms, the cost is less than $1,000 per month and is identical to rooms that people are paying over $2,500 for. What’s the catch? Well, in order to qualify for one of these rooms, you must have less than $2,000 in assets. Furthermore, since these rooms are in such short supply, being in the right place at the right time helps. In my informal survey of about 15 assisted living facilities, a few had current openings while others had a waiting list of two to three years. Some people move into an assisted living facility with the plan to pay for two or three years and hope that a GAFC room becomes available when they are out of money. Here is a real example from one of my recent cases;
It was late at night. “Anna”, a 79 year old widow, was in the parking lot screaming! Residents of the apartment complex heard the commotion and called the police. “Anna” was pink-slipped by a social worker from protective services. Pink-slipped means that she was taken to a hospital, against her will. The apartment complex changed her locks and told “Anna” not to come back.
“Anna” had a short stay in the hospital and was then transferred to the dementia unit of a nursing home. But don’t worry; this is when “Anna’s” luck started to change. At the hospital “Anna” was diagnosed and treated for a vitamin B-12 deficiency and a urinary tract infection. The combination of these two conditions caused the confusion and dementia that “Anna” had been suffering from. “Anna” and the nursing home staff soon realized that “Anna” should not be in the dementia lock-down unit. In fact, it was determined that “Anna” should not be in a nursing home at all! Anna did have some needs, such as someone to make sure she took her medicine and to get her cigarettes, but definitely did not need nursing home care.
So what were her options? “Anna only had $6,000 in savings and $800 per month from social security. We could have gotten her back into her apartment because she was illegally evicted. A landlord may not kick you out and change your locks without a hearing. We decided to look into assisted living. For the unit that we found for “Anna” the monthly rent was $2,580. The director of the assisted living facility told us that she had a GAFC room available and that the rent would be reduced to $983. We were on the right track but “Anna” still couldn’t afford paying rent of $983 for long when her income was only $800 per month. Anna also had a Blue Cross Blue Shield health insurance policy that cost $237 per month.
“Anna” took the GAFC room and we applied for Supplemental Social Security (SSI). This solved two problems. First, by getting SSI, this raised “Anna’s” social security income from $800 to $1,053 per month. By getting SSI, she was automatically enrolled in MassHealth. MassHealth will pay 100% of her medical expenses with no deductibles. She now has enough income to pay for her assisted living and has complete medical coverage allowing her to cancel her other health insurance. This was a win win situation. Now “Anna” has a safe place to live, three meals a day, and health insurance. The downside is that “Anna” only has an excess of $70 per month for her personal needs, and a pack of cigarettes per day will more than use up that excess.
Next week I’ll discuss the Personal Care Assistance program offered by MassHealth. This is a program that covers all or part of the cost of having a personal care assistant at your home. It is a way of being able to stay at home and have the state help to pay for the care to avoid having to be placed in a nursing home
This article gives general information and not specific advice on individual matters. Persons wanting individualized advice on matters discussed should contact an advisor experienced in those matters. To the extent this article provides information on legal matters, it is based on law in effect in Massachusetts on the date of posting (laws in effect in other states are often quite different).
Ronald H. Surabian is a CPA and attorney who works at the Elder Law Center in Saugus, Massachusetts. He also holds a masters in accounting and a masters in tax law. He currently serves on the board of directors of the Massachusetts Chapter of the National Academy of Elder Law Attorneys. If you have any questions please call me at the Elder Law Center, One Essex Street, Saugus, MA 01906 (781)233-4444. To view this or any prior article, please visit our web site at www.elderlawcenter.org