How can an older adult afford home care these days?”

Mrs. Jenkins is an active older adult in the community. She volunteers at the senior center, drives her neighbors to medical appointments and was her husband’s primary caregiver until his passing. Mrs. Jenkins is on a limited income, does not have long-term care insurance and recently suffered a stroke. In order for her to return to her home safely she must obtain the assistance of a caregiver to help her with showering, preparing her meals, and transportation to medical appointments. Mrs. Jenkins’ children live locally; however, they are employed and unable to provide the care she needs.

The family is desperate to find a solution but her income is too high for Medi-Cal benefits and too low to pay privately for care.

The example of Mrs. Jenkins is a common situation for older adults in our community. Often times the older adult will have to too much income or too many assets to be considered for Medi-Cal benefits. Yet their income is too low to pay for care. These individuals and their families often feel stuck because there is little assistance readily available. The cost of paying for care privately may be too substantial and not leave enough funds for the adult to provide basic necessities. This may cause an increase in ailments, such a malnutrition or noncompliance with medications due to prescription cost, thus increasing hospital admission rates. So, the question remains: What is available for these middle bracket individuals to allow them to remain safely in their homes?

In working with older adults as a geriatric care manager with Elder Options in Lake Tahoe and Placerville, I commonly assist families in locating appropriate entitlement programs. Two such programs are the Veterans Basic Pension and the Aid and Attendance benefit. The Aid and Attendance benefit is an increase to an individual’s basic pension and is available to a veteran as well as their surviving spouse. This benefit provides a monthly sum of money that allows for the adult to pay for caregiving services. There are several requirements for this program, which include income, disability status, as well as the time served.

The issue remains whether this entitlement program can truly assist the older adult and, if so, what is necessary to complete the application. The Aid and Attendance benefit has assisted numerous veterans or their surviving spouses with remaining in their own homes or even transitioning to an assisted living facility with the monetary resources to do so. The monthly benefit can vary from $1,000 to $2,000 a month. There is an application process, which requires several pieces of information including birth certificate, medical expenses and financial information. The application process is often long but well worth the wait. The Department of Veterans Affairs will often take six to eight months to process a claim. However, once the claim is approved they will back date to the date the application was received. A lump sum payment will then be issued to the veteran or surviving spouse.

Entitlement programs, such as VA Aid and Attendance are often not discussed until a crisis occurs. Future planning, including researching if one qualifies for a basic pension, is a great place to start. Once the pension process is started the additional Aid and Attendance benefit will be easier to obtain in a timelier manner, thus allowing for the adult to remain safe at home with the proper care.

For more information contact [email protected], call (530) 541-1812 Lake Tahoe area or (530) 626-6939 Placerville/El Dorado Hills area or visit

Special to Village Life

Discussion | 1 comment

  • Mike RobertsApril 01, 2013 - 11:29 am

    Great information Liz. As someone who recently went through much of the above with my mother, I'll add a couple observations: El Dorado County has excellent Veteran's benefits counselors. Ed Swanson and his crew understand the complexities of the Aid and Attendance requirements as well as anyone. They helped me understand that A&A does not cover independent living expenses. It is for assisted living and in-home care. I learned that the Aid and Attendance benefit was widely abused in the past. At one point I sought private advice and was encouraged to bill myself out to my mother way beyond the time I actually spent with her.... All this to offset her modest income and thus qualify for A&A. My refusal was less ideological than practical... I would have had to claim all that money as income, might even need a business license, and the resulting hit on mom's cashflow would have left her unable to make ends meet, so she would have to pay down her meager savings for living expenses, which would have demoralized her. I was told that doing all this is a normal occurance. Seniors don't want to leave their homes, and in many cases it makes sense to let a parent age in place. But many widows and widowers end up in inappropriate houses... too big, too expensive, too many steps... too far from essential services. Many retired to El Dorado County and built their dream house in the country with their spouse and are now stuck out there by themselves.I have an elderly neighbor with back and hip problems hauling firewood in for her stove all winter.... crazy. Her gorgeous home has a sunken living room. Those two steps down are a huge challange and a major risk factor now. As us baby boomers age, we need to learn about appropriate housing from the Greatest Generation. We need to think about being close to services, and unless we retired wealthy, we need to adjust our expectations about the size and ongoing costs associated with our domicile. No one wants to give up their home, but in many cases, living there alone makes no sense. Be proactive. Sell it, take the profit, and get something appropriate.The decisions won't get any easier. One last thought. Reverse mortgages have taken a lot of heat, and the upfront take is steep.... about 10% I believe. But they provide a vehicle to allow seniors to age in place for as long as practical. My dad set it all up and when he died mom continued to live in their home comfortably for several more years. But many seniors, like my mother-in-law, are hesitant to impact their children's inheritance. I apologize for getting all preachy here, but us boomers should act responsibly and assure our parents that it's OK to take the equity they've accululated and use it to meet their late-life needs, even if that means a reverse mortgage. Above all, get some advice. We used Elder Options here in Placerville. My wife and I bounced the big decisions off Carole Heape, who was a Godsend. Mom died in January. In hindsight, I'm OK with how the final couple years played out. Everything we did was made possible by her agreeing, finally, to give up her home in suburban Chicago and move to Gold Country independent living here is Placerville. I spent all the emotional currency I had and then borrowed up to my credit limit on that decision... to no avail. In the end it took a polite intervention by a condo neighbor she respected. I barely knew the woman, but poured my frustration out to her in the condo garbage room late one night. She stopped by for coffee the next morning and a half hour later mom decided to move. The lesson for this boomer was "ask for help." Talk about your situation. Other people have been down this road before you. The circumstances and decisions around the late-life care of a parent are fluid. It requries flexibility, patience, grace, and a lot of advice. I got invaluable guidance and support once Mom was in Placerville from the staff at Gold Country, Marshall, Snowline and Elder Options. But the very best advice actually came from a neighbor. Thanks Dave. The staff and residents at Gold Coungtry were good to mom. She even liked the food. Like so many others there, she wondered why she'd waited so long to make the move. Best of all, after living a couple thousand miles apart for the last 35 years, we got to know each other as adults, her parting gift to me.



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