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  • Alan D. Feller, Esq.

Avoiding the Nursing Home

For most of our lives, the familiarity, comfort and security of one’s home is taken for granted. The sudden onset of illness or a hospitalization may complicate the plans for continuing residence in your home. There are tangible and intangible factors that contribute to a successful return with workable home health-care.


A basic element of maintaining a positive home care environment is the living space itself. Is it clean and uncluttered or is it a hoarding nightmare? Is there a viable one-level solution or are there too many stairs and ill-suited rooms? Do the appliances work? How about the boiler, the roof, the windows? Is there mold? A cleaning service may solve one problem, but other issues may require renovations.


This leads us to the most important element in the home care equation – the primary caregivers. Ultimately, the support system for a loved one struggling with an illness governs their trajectory. Even with sufficient financial resources to remain at home, if there is no point person willing to manage and coordinate all the disparate pieces that make up care in the home it will not work. What is involved? Make sure there is food in the refrigerator and the pantry with someone available to feed them. Bills have to be paid and home health aides hired. Arranging doctor visits and transportation require patience. There is also laundry, trips to drug stores and wardrobe purchases. Smart caregivers delegate and utilize professional services. Home care as a long-term solution can also be very expensive. In New York State, Medicaid has a home care program that pays for care. Eligibility requirements are not as stringent as nursing home Medicaid – there is no 5 year lookback or transfer of asset penalties. Excess income can also be protected with the use of Supplemental Needs Pooled Trusts.


A solid home environment, engaged caregivers and a sensible financial plan for long term care combine to offer the best chance for avoiding a nursing home when an illness strikes. The delicate balance of these forces must be monitored closely. Overburdened care-givers juggling jobs, children and caring for a loved one are always in danger of burning out. What do you do when home care becomes more challenging?


Luckily, there are intermediate solutions when home care is not feasible. Assisted Living facilities offer medical supervision and social support while still prioritizing lifestyle and independence. Some Assisted Livings have memory care units and other specialized services. Assisted Living facilities are not nursing homes and though most are private pay, some are Medicaid approved with the same basic eligibility as home care Medicaid.


There are situations where a nursing home makes sense. Even with a suitable house or apartment and an actively engaged support system the health care needs of the loved one may be too difficult to manage effectively. Behavioral changes due to dementia, dialysis, nutritional imbalances and a whole range of other problems can challenge even the most able care giver and rise above the thresholds for assisted living.


There are well-travelled paths for avoiding a nursing home when a long-term illness hits. A sound first step is to reach out and talk to the professionals at Sloan and Feller for guidance.




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