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Published Wednesday, March 23, 2016

When It’s Time to Pay for Assisted Living

Senior Solutions

By Rick Weisberg

When exploring the financial aspects of moving into assisted living, each situation is different and needs to be evaluated on its own merit.

Q: It’s time for my 85-year-old mother to move to an assisted living facility (ALF). She’s been resisting the idea for the past few years, but after a small fire in the kitchen and a bout with pneumonia, she too believes it is the right move. We are hoping to find her a one bedroom apartment north of Boston, but are not sure if she can afford the monthly rent. What are the typical financial criteria required by an ALF and are there alternatives besides private pay to help cover the monthly charges?

A: As you might expect, there is no short answer to this question, but let’s take a look at all the available options. ALFs normally admit residents who possess two to three years of liquid funds, which will enable them to pay the monthly rental fees for that time span. Therefore, if the monthly rental including care charges is $6,000/month, then the ALF is looking for at least $150,000 in liquid funds. Additionally, social security and/or pension can be used toward the monthly rental charges. Long Term Care Insurance policies are also an option; some policies pay for a portion of the monthly rental at an ALF. It is also possible to access Veterans Benefits if the resident or the resident’s spouse was a veteran and they financially qualify.

Most people assume MassHealth (Medicaid) will cover the costs of an ALF and it is definitely a resource, but here is where it gets complicated. There is a limited MassHealth program called Group Adult Foster Care (GAFC) which is available in some ALFs. However, you cannot be admitted on the GAFC program. You would need to pay privately – typically for two-plus years – then if you financially qualify, you can apply for and be approved for the GAFC program. Keep in mind that most ALFs that offer GAFC dedicate a limited number of apartments to this program.

Yet another option: the Program of All-inclusive Care for the Elderly (PACE). Although this program is less common than GAFC, it is expanding each year. Currently 31 states in the country, including Massachusetts, offer the PACE program. This is a government plan and available to people who have Medicare or Medicaid and qualify for the program.

Families often ask me if they should move a parent into a nursing home – as opposed to an assisted living facility – since a new patient can be admitted on Medicaid. While this is certainly an alternative, note that in order to financially qualify for MassHealth/Medicaid an individual needs to “spend down” his or her money to $2,000. Assisted living facilities are less expensive and less medically intensive than nursing homes, which can cost $12,000-$15,000 per month here in Massachusetts. In addition, nursing homes generally do not offer the apartment/home-like environment of an assisted living.

There’s obviously a lot of information to digest when it comes to exploring the financial aspects of moving into an assisted living. Each situation is different and needs to be evaluated on its own merit.

Send questions about senior issues to rick@assistedlivingnationwide.com or mail to Senior Solutions, 27 Congress Street, Suite 501, Salem, MA 01970. Rick Weisberg is president of Assisted Living Nationwide, a firm that helps seniors and their families find the most appropriate assisted living facility, based on the family’s criteria. There are no fees for his services. Rick is also a realtor and is affiliated with Benoit Mizner Simon & Co. Contact Rick at 617-513-7067.

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