Between a Long-Term Care Rock and a Hard Place

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In mid-March, my mother called me from the hospital. My father was sick. Fever, chills, cough, general weakness and other flu-like symptoms. As it turned out, it was the wrong month of the wrong year to have “flu-like symptoms.” Despite being convinced that he had COVID-19, the hospital could do little more than give him a swab test and send him home.
For the next four-and-a-half weeks, my father and mother stayed on separate sides of their two-bedroom apartment. My mother, who was dealing with her own symptoms, was able to tend to my father’s needs, and at times, things got scary. Thankfully, all is now well.
No matter how bad it was for them, it could have been a lot worse. My father’s hospital stay could have been longer, resulting in him having weakened limbs and needing rehabilitation. The illness could have been more debilitating, creating lasting, long-term care needs for him or both of them. Their residence, to begin with, could have been an assisted living facility or a nursing home. They could have had pre-existing conditions, which put them at higher risk of succumbing to the virus.
Many people who already require long-term care have not been so lucky—and whether they’re being cared for at home, or in an assisted-living residence or a nursing home, it’s become that much harder to care for them on a long-term basis. By adding COVID-19 into the mix, every contact with
a caregiver could result in a disaster for both parties.
Actually, long-term care has never been all that easy. Strokes, falls, dementia and other ailments for seniors still exist. If anything, those issues and the needs that go with them have only increased in the last few months. The question of where long-term care can be provided, who will provide it and how it will be paid for is still crucial and needs to be answered. To complicate matters further, Medicaid, that which covers the majority of long-term care costs in the country, is on the verge of monumental changes in New York, that will impact the long-term care landscape for the foreseeable future.
Historically, there have been two types of long-term care coverage under Medicaid: Custodial Medicaid, or care in a nursing home; and Community Medicaid, or care at home, in an apartment, senior living community or a family member’s home. For Custodial Medicaid, we have become accustomed to the “five-year look-back period” and the need to plan ahead for the possibility of the need for a nursing home later in life. But Community Medicaid has never had a look-back period. The absence of one means that one can qualify, financially, for long-term care assistance at home in a matter of a few days.
The 2020 New York State budget, however, has done away with this last-second planning luxury. Starting this October 1, applications for Medicaid coverage for long-term care assistance at home will require 30 months of documentation and implementation of a two-and-a-half-year look back. This change will simultaneously make it more difficult to qualify for home care services and that much more important to plan ahead. The change will also increase the number of people filing applications for home care via Medicaid between now and October 1—before the change goes into effect.
More and more people are looking at home as the best location for long-term care, particularly because of the COVID-19 crisis. This fact, coupled with the changes to Medicaid, could make the situation dicey.
So please make sure you plan ahead.

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