Help With Home-Care Bills
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If assets or income disqualify your parents from Medicaid benefits, it’s still possible to find public and not-for-profit programs that either subsidize home care for middle-income people or offer aid in other ways.
Start by checking with the state or county department on aging where your parents live. You can find it at eldercare.gov, a site run by the Administration on Aging. Another useful website is payingforseniorcare.com.
Here are steps to take if you’re not Medicaid-eligible:
Look Into Government Programs
• Investigate PACE. Programs of All-Inclusive Care for the Elderly is designed to keep Medicaid- and Medicare-eligible people out of nursing facilities. Participants can get in-home care, including help with activities of daily living, such as meals, dental and medical care, prescriptions, and chaperoned transportation, among other benefits. It’s available in 32 states, though not in every community. (In some states, PACE is called LIFE, for Living Independence for the Elderly.) Medicaid-eligible patients get the service free. Others may be charged a monthly premium, though far less than they would pay a private service.
• See what your state provides. In some states, seniors who don’t qualify for Medicaid can participate in reasonably priced, state-funded home-care programs. Participants are responsible for an income-indexed monthly co-payment.
Enlist Volunteers
• Find a companion. The Senior Companions program of the federally funded Corporation for National and Community Service sends volunteers into homes to help with nonmedical daily living tasks. These companions are at least 55 years old. They spend 15 to 40 hours a week serving two to four senior clients.
• Accept a helping hand. Assistance networks run by religious organizations and other nonprofits coordinate volunteer programs in some states. In Minnesota, volunteers from the not-for-profit Living at Home Network help 10,000 seniors with transportation, home-delivered meals, home chores, some nursing care, and accessibility modifications, such as building wheelchair ramps.
• Get free meals. Any homebound senior or disabled person is eligible to receive Meals on Wheels, though the focus in many communities is on lower-income recipients. Most clients get one meal per day. Volunteers deliver meals, socialize with the elderly, and assess their living situation for safety—a plus for someone living alone. There may be a waitlist in your area. For information, go to mealsonwheelsamerica.org.
• Care for the caregiver. Respite services help unpaid caregivers refuel mentally and physically by providing a qualified person to take over for a few hours or overnight. Services may be available through your state or local Area Agency on Aging or through a not-for-profit. The care may be offered free or for a fee far below market rates. Find local respite programs through the Respite Locator at Access to Respite Care and Help (ARCH).
Take Advantage of Tax Breaks
• Claim your parent as a dependent. Check with a tax professional about whether you should claim a parent as a dependent on your federal return. You can take that step regardless of whether you live together if you pay for over half of his or her support and your parent’s gross income is less than $4,050. (Tax-exempt income, including certain Social Security benefits, isn’t considered in that total.) You also may be eligible for a dependent-care tax credit; see IRS Publication 503, “Child and Dependent Care Expenses,” for details.
• Write off medical costs. If home care means costly supplies, services, and modifications to your relative’s home, your family might save more money by having a lower-income senior claim them on his or her own taxes.
Only the unreimbursed costs that exceed 10 percent of adjusted gross income are deductible. Go to the deductions section of the IRS’ Interactive Tax Assistant or consult a tax pro.
• Use employee benefits. If the senior is your dependent, you can contribute up to $5,000 in pretax dollars to an employer’s dependent-care flexible spending plan and $2,600 to a medical flex account. At a marginal tax rate of 28 percent, you’ll save $2,128 putting away those maximums. Savings in a tax-favored health savings account can be used the same way toward the qualified medical expenses of your dependent parent.
Don’t Give Up on Medicaid Eligibility
Even if your parent can’t spend down assets in time to qualify for Medicaid, investigate strategies to make him or her eligible. Diverting some income to a trust may do the trick, says Bernard Krooks, an estate and elder-law attorney based in New York. These legal vehicles go by various names, including a Miller Trust, pooled income trust, or Qualifying Income Trust.
New York State is particularly generous to seniors seeking Medicaid-funded home care. When care will be at home, the five-year Medicaid “look back” period for depletion of assets doesn’t apply. Seniors can transfer their money to family or trusts as soon as one month before applying for home-based “community Medicaid.”
“The risk, of course, is that if the senior then needs nursing-home care, the five-year look-back still applies for Medicaid-funded care,” Krooks notes.
Editor’s Note: This article also appeared in the December 2017 issue of Consumer Reports magazine.
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