Family finances strained by cost of parent's care

Expenses of caring for elderly family members affect the entire family's economic welfare; know what options are available.

By Jan Warner and Jan Collins, Special to the Times
Published August 28, 2007

Q: Since my mother-in-law suffered a stroke nearly two years ago, my wife and I have cared for her in our home. When we saw that we could not handle this part-time and could not get my wife's siblings to help, my wife stopped working to stay at home with her.

Recently, my mother-in-law was diagnosed with dementia, and we just can't care for her any longer. We tried to find a facility that would admit her, but because she has only $1,500 to her name and $720 per month in Social Security, the nursing homes tell us there is an 18-month wait for a "Medicaid bed." They can't take her unless my wife and I guarantee to pay for her care at more than $5,500 monthly. We are at our wits' end.

A: Yours is a prime example of how long-term care may have an intergenerational impact on the family: Your wife stops work to care for her aged mother which, in turn, reduces your current family income and drastically changes your family's retirement planning, passing responsibility on to your children should you require this kind of care.

Often, the most difficult questions faced by families who care for disabled persons are if and when that individual should be admitted to a nursing home or other kind of care facility.

In addition to the personal conflicts surrounding these questions, a variety of legal, medical and financial issues must be considered.

If your mother-in-law had the funds to pay privately for her stay in a facility, there would be no obstacle to her entering a nursing home, regardless of the state of her health. However, for her stay to be paid for by Medicaid, rigid medical and financial requirements must be satisfied.

Based upon her assets as you describe them, she will meet the financial criteria, but she might not meet the requisite medical criteria. So before moving down the planning path too far, we suggest that you and your wife make sure that institutionalizing your mother-in-law is the appropriate option, by having her functional capacity assessed by a qualified geriatric care manager.

Once a clear picture of your mother-in-law's care needs is available, you will be better able to determine the required level of care - which might not be in a nursing home. If this is the case, there may be other options for you to consider, not covered in this column because of space limitations.

But assuming she meets the required medical level of care, your next hurdle is gaining her admission to a Medicaid-certified facility.

While the Nursing Home Reform Act of 1987 (NHRA) is credited with bringing about nursing home regulation reform and with strengthening individual rights, Congress did not go far enough when it comes to situations such as yours. The admission process in most states is far from organized or fair.

Because there are no centralized application procedures, in order to find a bed, you must visit a number of facilities, complete an application at each, and be placed on a waiting list for a bed.

You can learn more information about elder care law and write to the authors on www.nextsteps.net. Jan Warner is a member of the National Academy of Elder Law Attorneys; Jan Collins is editor of the Business and Economic Review, published by the University of South Carolina.