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From Nursing Home to Community Living – Could This Work for You?

By Winston Law Group in Elder Law, Medicaid (Masshealth)

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Given the number of options available for at-home care and financial assistance from state Medicaid (called MassHealth or CommonHealth in Massachusetts) programs, we are now seeing a growing trend of nursing home residents regaining their independence and transitioning back into the community. This is a very attractive possibility for those individuals needing an increased level of care at some point in their life, but do not wish to permanently reside in a nursing home setting. Both the federal and Massachusetts governments are committing substantial resources to transitioning individuals back into community settings after a nursing home or rehabilitation stay.

Nursing home residents currently receiving MassHealth can typically transfer that benefit to in-home care services. This is a tricky process, however, and many factors should be considered before the transition can occur. If you believe that a loved one would benefit from a nursing home to community transfer, consider the following:

Do they want to live independently? Often the hardest hurdle to overcome is the senior’s desire to thrive on their own and overcome the obstacles associated with independent living.

Can they safely live independently? Are they mobile? Safety is of the utmost importance here and should weigh heavily on the decision to transition into the community. Mobility is also important and helps in determining the level of skill needed by caregivers. A senior that requires around the clock supervision and mobility assistance may not be the best candidate.

Is the home safe and accessible? Safety features and accommodations such as wheelchair ramps, lifts, accessible bathrooms and showers should be considered and will vary depending upon the senior’s degree of mobility.

Can the senior afford independent living? In addition to Social Security and any income derived from pensions or retirement plans, additional public benefits such as community based MassHealth or certain veterans benefits may be available and could potentially provide considerable financial assistance. However, qualifying for community level care is a complicated process. Eligibility should be reviewed with an experienced elder law attorney before the transition occurs to ensure that the senior has the appropriate level of funding to meet their daily needs.

What additional, non-medical services may be needed? Often times, people forget the non-medical skills needed to live independently, such a bill-paying, food shopping, cooking, cleaning, transportation, etc. If the senior is unable to do one or many of these things on their own, you may have to delegate these tasks to family members or friends. It may also be worthwhile to retain the services of a private care organization for assistance.

Transitioning from a nursing home to community setting can be an overwhelming process. Family members should look to their local elder service providers, such as their regional Elder Services program or their community Council on Aging to determine if they are able to assist or provide advice for programs with the transition. Private care companies, such as Life Care Directions of New England, can also assist the family with completing some of the necessary but often burdensome steps of the transfer, such as setting up bank accounts, securing suitable and safe living arrangements, making accommodations in the home, setting up the necessary medical care and managing non-medical services.

The key is to plan well in advance of the transition and utilize the assistance of skilled legal professionals and expert care mangers to guide you and your family through the process. And ultimately, the most important consideration should be whether the senior can receive the adequate level of care while continuing to live safely and thrive in a community setting.