The delicate balance of care options

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When you or a loved one become unable to completely take care of yourself, the question, “What care option is best?” becomes important to answer. While it is important to consider one’s personal wants and needs, it is equally important to weigh out what the future may hold in terms of changes in the type of care needed. With care being so expensive today, you may need to look into applying for VA benefits or Medicaid to help pay for your care, adding another challenge to balancing and planning for the care that may be needed. The following is meant to help you understand in more detail what needs to be considered as you make these decisions.

In-home care

One option people tend to start with is an in-home caregiver. You can obtain an in-home caregiver either independently, or through an agency. If you have a non-agency caregiver for which there is no record of payment, as many people do because it can be more cost effective, it is vital that you enter into a caregiver contract with that caregiver. This will allow you to prove to the VA, and eventually Medicaid, if needed in the future, that this caregiver was paid at fair market value and at a certain amount per hour. You must also obtain the necessary medical opinions indicating that the caregiver is a necessity, and then document the caregiver expenditures. Once there is a physician’s opinion, a contract in place and documentation of the caregiver expenditures, a VA application or Medicaid application is in a better place for submission.

VA benefits may help

It is important to know that, in order to qualify for VA benefits, your unreimbursed medical expenses must exceed your income. For example, if you have a monthly income of $1,700 in Social Security, and pursuant to the caregiver contract, you are privately paying a caregiver at the rate of $15 per hour for 40 hours a week, the result is a monthly expenditure of $2,400 per month. This would more than offset your $1,700 per month of Social Security income, thereby potentially enabling you to qualify for maximum VA benefits of about $1,000 per month.

How long is too long to spend money on in-home care?

Let’s say you have an in-home caregiver and have been paying them for a while. The question now becomes, “How do I plan for the day that I run out of cash, and require either assisted living or nursing home care?” The problem with in-home caregivers is that you can expend all of your monies with them. When you run out of assets with a caregiver at home, you will not have built any goodwill with a Medicaid facility, whom you are now asking to care for you for the rest of your life. It is important for you and your family to understand that, at this point, while you may want to stay at home, if all of your funds are depleted from paying for an in-home caregiver and your health is declining, then you will subsequently have no money to offer as “key” money to a facility, either assisted living or skilled care, when and if you need to move from home to a higher level of care.

Can you stay too long in an assisted living facility?

Going to an assisted living facility may not be the answer either, though. The result can be the same in an assisted living facility as it is with the private caregiver. Once you run out of money at an assisted living facility, they will thank you and ask you to leave. All the goodwill you built with the assisted living facility becomes worthless when you then enter a skilled care facility, for which you now have no money to offer, and with which you have the eventual hope of Medicaid eligibility.

A balanced approach

A better approach would be to balance the situation by staying at home with a caregiver, or staying in an assisted living facility, as long as possible, but not spend down to the point where you do not have at least enough assets to cover one year of private pay at a Medicaid facility with which to make yourself an attractive candidate for a skilled care facility of your choice.

Thus, while the extra $1,000 per month from the VA may help keep you at home longer, don’t stay at home or in an assisted living facility too long, putting yourself in the position to not have available monies to make you an attractive candidate for a skilled care facility. Keep in mind that a skilled care facility may eventually take Medicaid, and you may need such a higher level of care in the future, which can be very expensive, and will require some initial “key” money payment. This is a very delicate balance that you can only achieve with your eyes wide open and with sensitivity to your wishes, while also being circumspect about protecting yourself now, as well as in the future.

For more, call 847-292-1220, e-mail or visit

About Anthony B. Ferraro

Anthony B. Ferraro is the founder and managing member at the Law Offices of Anthony B. Ferraro. He received his Bachelor of Science degree in accountancy from DePaul University and his Master of Science in taxation. After receiving his CPA designation in 1978, he enrolled in law school, earning his Juris Doctor in 1983 from De Paul University. An elder law practitioner, his practice areas include Medicaid planning and applications, guardianship, probate & trust administration, long-term care planning, nursing home contracts and admission, senior estate planning, special needs planning, estate planning, and estate taxation.

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