Aging in place is a growing movement in elder law planning. Its goal is for people to plan ahead so they can live safely and independently in their own homes and communities as they age, and avoid moving to a nursing home.
There are many reasons for aging in place. Seventy percent of adults over age 65 will require some type of long-term care during their lifetime, but 90 percent report they'd prefer to stay in their own home as they age. We typically become more intolerant of change as we age, and cling to familiar places and routines. Even if you find a quality nursing home, the abrupt and drastic change can adversely affect our mental health. In-home and community-based care give seniors a sense of continuity, while satisfying their need for more intensive medical support and companionship.
Aging in place is also a practical necessity. The 76 million baby boomers are hitting retirement age in record numbers. Fourteen percent of today's population is over age 65; by 2030, that will increase to 20 percent. At the same time, the number of available nursing homes is decreasing each year, falling nearly 10 percent from 2000 to 2010. The shortage is fueled by many factors, including aging infrastructure, the recession, and decreases in the amount of Medicare reimbursement rates. If these opposing trends continue, we'll have no choice but to find more alternatives to nursing home care.
One alternative is having family members provide care to the senior in their home. Many family members do so out of love and affection, neither wanting nor expecting compensation. But as the senior ages and requires more care, the family member may have to consider quitting their job to continue as caregiver. At that point, the senior may consider paying the caregiver. This allows the senior to stay in their own home and to receive care from someone with whom they are familiar and at ease.
Despite the benefits of having a paid family caregiver, families must be cautious in setting up these arrangements. The senior's condition eventually may deteriorate, and they might need to be admitted to a nursing home. If the family then applies to MassHealth to pay the costs of the nursing home, they will be penalized if the senior gave away any assets during the prior five years. MassHealth normally presumes that family members provide care out of love and affection. Even if the senior gave the caregiver money, MassHealth may see this as a voluntary gift in appreciation. To avoid this risk, the senior and the family caregiver should sign a written personal-care contract, which creates a legally enforceable obligation to provide and pay for services.
The personal-care contract should specify exactly what types of care the family member will provide, how many hours a week and the hourly rate of pay. You should research and compare rates for comparable services in your area. If the senior plans to move into the family member's home, and it needs modifications to accommodate their medical condition, the contract can provide that the senior will pay for these modifications. Once you have a contract in place, the caregiver should keep a written, detailed log of hours spent on caregiving, so that they can document for MassHealth that the contract wasn't illusory.
We all need to start thinking of practical ways to age in place. If you decide to have a family member provide in-home care for a senior, protect yourself in advance with a written personal-care contract.
Robert Deschene is an estate and elder law planning attorney at Deschene Law Office in North Attleboro, and a member of WealthCounsel and the National Academy of Elder Law Attorneys. Contact him at 508-316-3853 or by email at firstname.lastname@example.org.