The virtues of aging at home have been trumpeted for decades. A home can be modified and adapted for a homeowner’s continued use while still maintaining familiarity and continuity. Home health aides can be hired for day-to-day care and trips to senior centers can provide the necessary social stimulation. The argument in favor of staying in one’s home and fighting the good fight is persuasive most of the time. Experience has taught me that simple narratives do not always translate into the best results.
Medicaid provides the funding for long term care in New York. Nursing home care and home care are the most heavily utilized living care options for seniors requiring health assistance. Both services are covered by Medicaid. Medicaid for nursing home care requires a five year lookback for transactions while Medicaid Home Care does not require a five year lookback. A third option that seniors have access to is the Assisted Living Program or ALP Level III which is also covered by Medicaid and does not require a five year look back. Home care and ALP Level III do not penalize asset transfers and both follow community resource Medicaid Budgeting. The Assisted Living Program is designed for those individuals who require greater care assistance but also can enjoy the benefits of impactful social interaction and intellectual as well as physical stimulation.
Assisted Living facilities may superficially resemble a hotel or college dormitory, but there is a real push to combat a senior’s isolating behavior by opening them up to increased social participation. Besides the more forgiving architectural layout these facilities are designed for intimacy, comfort and accommodation. The housing stock in the Hudson Valley, generally speaking, was not designed for aging in place. The mid-century raised ranches we grew up in opened into small landings requiring an ascent or descent into a living space. Center Hall Colonials and traditional ranches are somewhat better suited for aging homeowners, but there is always a logistical issue to address. Sitting in front of the TV for 10 hours a day while an aide hovers in the kitchen is not the optimal social environment that we can offer to our parents. Watching a loved one forming new friendships or chatting up a tablemate at lunch is a step in the right direction.
New York’s long term Medicaid programs show the state’s commitment to supporting a variety of care arrangements. The ALP Level III program is not well publicized, but its advantages are tangible and the Medicaid funding support makes it a win-win for families looking to protect the financial legacy of a loved one.