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No reasonably healthy person hopes to end up in a nursing home. Many family members struggle with guilt about admitting their loved ones to nursing homes. Relatively recent changes in Medicaid funding have made it possible for people to care for their elderly family members at home instead of having them admitted to the nursing homes. That change, combined with emotional desires to avoid nursing home care leads many people to bring family members home, even when home healthcare is not the healthiest or smartest alternative.

State Medicaid benefits support nursing home residents when they cannot afford to pay the cost of their nursing home care. Medicaid only pays for such care in a nursing home as a general rule, but a patient can apply for an Aged and Disabled (“A&D”) Waiver to get financial assistance with the cost of nursing home-style care at home. Home healthcare is usually much less expensive than nursing home care because patients only pay for the professional nursing, therapeutic, and respite care services that they use instead of sharing operational and facility maintenance costs of nursing home care.

The A&D Waiver application process as a step to the Medicaid application process that nursing home residents must follow. A&D Waiver applicants must apply for wavered services through the applicant’s Area Agency on Aging. Agency staff evaluates each applicant’s needs for some of the following services (many of which are included with nursing home care):

Adult Day Services, Attendant Care, Case Management, Homemaker, Respite, Adult Family Care, Assisted Living, Community Transition, Environmental Modifications, Health Care Coordination, Home Delivered Meals, Nutritional Supplements, Personal Emergency Response System, Pest Control, Specialized Medical Equipment and Supplies, Transportation, and Vehicle Modifications.

The agency adds the applicant’s name to a waiting list and grants the waiver application when waiver funding becomes available (the waiting list time shrank from almost 12 months to just a few days over the past decade). Once the applicant receives the waiver, the applicant must qualify financially and apply for Medicaid much like a nursing home resident must qualify and apply.

Family caregivers often underestimate the caregiving burden and overestimate the availability of professional home healthcare resources. An aged man or woman may risk serious personal injury by bringing home a spouse that cannot bathe or get in and out of bed independently. Demented patients often become unpredictably violent and verbally abusive toward their caregivers. Even the strongest and most determined caregivers often slip into chronic depression after enduring daily abuse from an Alzheimer’s patient, and the continuously grievous experience of the beloved family member’s deterioration. Some caregivers never rebound from such deep physical and emotional trauma.

Home healthcare is one of several common sense solutions to the rising cost of long-term care. In theory, most people prefer the home healthcare alternative to nursing home care. However, families need to weigh the physical, emotional, and financial costs of the two alternatives rationally and levelheadedly. A choice based on guilt usually leads to the worst possible outcome. The wise choice depends on what the patient needs and what the family can realistically provide in a safe and healthy manner.

Jeff R. Hawkins and Jennifer J. Hawkins are Trust & Estate Specialty Board Certified Indiana Trust & Estate Lawyers and active members of the Indiana State Bar Association and National Academy of Elder Law Attorneys. Both lawyers are admitted to practice law in Indiana, and Jeff Hawkins is admitted to practice law in Illinois. Jeff is also a registered civil mediator, a Fellow of the American College of Trust and Estate Counsel and the Indiana Bar Foundation;  a member of the Illinois State Bar Association and the Indiana Association of Mediators; and he was the 2014-15 President of the Indiana State Bar Association.

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