If you or your loved one is being discharged from a hospital or rehab facility, either to a home or to assisted living, focusing on the following six issues can be critical:

1. What temporary or ongoing assistance will be needed (home aide, meals, housekeeping)
2. How to remain healthy (proper medication management)
3. How to remain safe (a home safety plan)
4. Where will you find the aides you need, and who will manage them
5. How to manage care – family / friends or a professional Care Manager
6. A key, but often neglected, aspect of care is: How will you pay for it? Medicare will not pay for long-term care, and unless you are very wealthy, the cost of care can wipe out your entire life’s savings.

(Note:  Discharge to a nursing home is not discussed in this article) 

This checklist will give you a good starting point to keep yourself or your loved one happy, safe, and healthy as long as possible.  We also want to emphasize that you CAN protect yourself from financial disaster when health care costs start to climb.

When You Are Discharged, What Issues are Most Pressing?

Issue #1:  Help in the home, assisted living, or help in an assisted living

People coming from a hospital or rehab may need ongoing short or long-term care.  The institution’s designated liaison (usually a social worker) will recommend the appropriate level of care, based on the patient’s needs.  The social worker will also give a list of providers, such as assisted living residences or medical resources, that may be necessary for the patient’s care.    

 If the patient can go home, but needs more care, they may need to find an aide and/or access additional services.  Depending on the patient, specialty care physicians, visiting nurses, or other medical care may be necessary. 

If the discharged person needs an aide, finding one who is compatible will be a focus.  In the case of assisted living, the person’s mental capacity, physical state, and proximity to friends or family will all affect which facility is best suited for them, and how well they adjust to a new living situation.  Most assisted livings permit personal aides in their facilities.  Medicaid may cover home health aide services in an assisted living.

Issue #2:  Medication Management            

This is a thorny issue.  Home health aides are not permitted to administer medication.  They can put pills in a cup, place the cup on a table, and tell the person that “it’s time to take your pills,” but they can’t administer the pills directly.  For a person with dementia, or who has dressings that need to be changed, or physical procedures they can’t manage themselves, a home aide may not be enough.

Hiring a nurse to show up and give medications, or help with another physical need, is expensive, but it may be necessary.  One way to provide families with assistance instead of hiring a nurse is through the Consumer Directed Personal Assistance Program (“CDPAP”).  With CDPAP, aides hired by the family can be trained by the family, and then have fewer limitations on the care they are permitted to provide.

Issue #3:  A Home Safety Plan

Throw rugs, sharp corners, the path to the bathroom, poorly placed furniture, poor lighting – all of these and more can be a minefield of dangerous conditions, if you’re physically or mentally compromised. Fortunately, there are many printed and online resources and services that can help you create a safe living environment.

Issue #4:   Finding the Right Assistance

There are many excellent home health agencies.  The one the hospital recommends to you may be great – or it may not.  You may be happy with the agency, but if you are not, you can change.

It may take some effort to find an aide you are happy with – but that may not be the fault of the agency.  If you are unhappy with how the agency operates or manages your situation, find another agency.  Our firm’s Director of Client Care and Advocacy can give you a referral if you wish.

You may also choose to hire your own caregiver through the CDPAP program.  This choice requires more of your time and involvement than if you hire an agency, but will also give you added flexibility.

  If you decide to hire and pay your aide privately, we strongly advise against paying aides “off the books.”  There are a variety of serious issues and liabilities that can arise for the employer who does that.

Issue #5:   Does it Make Sense to Hire a Care Manager

If it is difficult for you to oversee the care, or if you don’t live nearby, you may wish to hire a Geriatric Care Manager (“GCM,” also sometimes called an Aging Life Care Manager).  A GCM can oversee the aides, check in with the patient, and generally manage the process.  The added cost needs to be weighed against the great peace of mind such a service can provide.

Issue #6:  How Will You Pay for the Care

Private pay aides currently cost $35-$40 an hour or more.   A hypothetical example for someone “who doesn’t need much care”:   6 hours a day, 5 days a week at $35 per hour (meaning all weekend care is left to family or friends) adds up to over $1,000 per week, almost $55,000 per year.  Double or triple that amount for people who need more help, or who need nursing care, or both.

No wonder people have anxiety attacks when they start paying for care.  They realize that even more expenses are on the horizon, and they see their life’s savings being depleted.  In the case of a married couple, they may have enough money to care for one spouse, but the surviving spouse may be left in serious financial peril.  If they don’t plan, most people literally face financial ruin. 

People are often told, “You have to use up all your money before you can qualify for Medicaid.  It’s called the spend down.”  This is not true, particularly in New York. 

Long-term care planning can allow you to remain in your home and maintain your lifestyle without using up almost every dollar of your savings, and the equity in your home, on your health care.  Proven legal strategies can allow you to protect yourself, your family, and your assets, and still access high quality health care.

The Bottom Line:

Our firm seeks to educate people about the possibilities available to them in New York.  If you own a home, have some savings, or have income from a pension or retirement plan in addition to Social Security, Elder Law planning can very likely result in huge benefits for your lifestyle, your savings, and your peace of mind.

Accessing care is complicated and stressful.  Lamson & Cutner created the position of Director of Client Care and Advocacy to enable us to assist our Elder Law and Estate Planning clients who need care services.  Our Director works with our clients to help them maximize the assistance they receive through Medicare and Medicaid.

If you or a loved one is in the hospital or a rehab facility, and have not yet done long-term care planning, discharge planning should kick-start your focus on this crucial aspect of your, or their, future.

We encourage you to read more on our website about Elder Law planning and Estate Planning, and to take action now.  Your relief and peace of mind from knowing you are protected will be well worth the effort.