Susan’s mother had always been extremely independent, working as a school superintendent well into her 70’s and living alone after the death of her husband over 20 years ago. Then it all changed in the space of just a few months. Her mother became forgetful, and at times would become disoriented. She had to step down from the job she loved, and it was not long before she could not safely live alone. Of her three children, two lived out of state, including Susan, and the son who lived closest declared himself incapable of providing support while Susan’s sister seemed overwhelmed at the prospect.

The above is a hypothetical and the people are fictional, but sadly, this is a common scenario. In the US, according to statistics provided by Merck, nearly 29% of older adults live alone, 70% of whom are women. In many cases, their children have moved away to establish their own lives and families, making it difficult to monitor emerging symptoms or issues. When those issues do become apparent, it is often as a result of a significant development such as a medical emergency or other incident that makes it clear the parent urgently needs assistance. Even when parents live together, a health crisis for one may be enough to make independent living no longer feasible.

If this situation describes you, know you’re not alone. According to recent numbers from the U.S. Bureau of Labor Statistics, there are 40.4 million unpaid caregivers of adults aged 65 and older in the U.S. alone, 13 million of whom are to provide that care from a distance. Even if you are not currently caring for an aging parent, you probably expect to at some point. A recent Pew Research Study found that nearly seven-in-ten adults in their 40’s and 50’s thought it was very or somewhat likely they would care for an elderly family member in the future.

Fortunately, wherever you may be on the caregiver spectrum, there are steps you can take to make it easier on yourself and your family. Know there is no one right way to care for a loved one from a distance. Each situation is unique and depends on a number of factors – care needs, resources, family dynamics, and how much or little your parent(s) can assist in the process. Before committing time and resources or rushing to a solution, do take the time to gather the information you need to make informed decisions and work on creating a family communication plan with any other siblings to make it easier to work together on care solutions.

In addition to all the logistics associated with developing a plan for caregiving, including identifying and accessing available resources, consideration will need to be given to the legal documents that may be needed such as powers of attorney, to help make those care decisions on behalf of your loved one. It’s never too early to contact an attorney knowledgeable in elder law and estate planning to ensure you and your family are prepared when the time comes. Providing long-distance care is never simple, but it can be easier if you anticipate those needs now.

It happens suddenly. A formerly independent family member can no longer navigate life at home successfully without assistance. Is it time to consider moving to assisted living or a nursing home?

Not necessarily.

In fact, according to a recent AARP survey, 76% of American adults age 50 and over wanted to remain in their current residence as long as possible. In addition to the emotional and physical stress of moving, there is the comfort of home and the connection of community.

For many seniors, their emotional ties to family and home coupled with the anxiety of a complete change in environment and routines can greatly impact their quality of life and even their life expectancy.

Fortunately, there are resources available to support individuals who want to stay home or even live with a family member. As our population ages, the home health care field is booming with an estimated $103 billion spent on home health services in 2018. Another rising trend is the Accessory Dwelling Unit (ADU), by adding living area to an existing home or creating what is commonly known as an “in-law apartment.” Recent changes in Centers for Medicare and Medicaid Services (CMS) reimbursement policy provide greater latitude for reimbursement of skilled home care than in the past. And, if a veteran or veteran’s spouse is in need of care at home, there may be additional resources available.  An advocate from your state’s office Office of Veterans Services can help you identify such as resources.

So, when does it make sense to pursue at-home care options? And, what of the financial costs of engaging long-term at-home support and/or creating living space in a family member’s home?

When considering how best to support an individual’s desire to age in place, accurate information and careful planning are key, particularly given the complexity of the interaction between private insurance, Medicare and Medicaid, and the potential impact on one’s estate.

For example, consider the case of an aging parent who needs skilled nursing level of care who is considering selling her longtime home and using some of the proceeds to build an ADU on her daughter’s home, and the remainder of the funds to pay for home services.

Are there any tax implications upon selling the home?

Will her daughter’s home now be considered partially her asset (and vulnerable

Will the expenditure of funds to build the ADU have an impact on Medicaid eligibility?

Will her daughter, who provides support during the day, be eligible for caregiver reimbursement, and if she wants to pay her daughter, are there any potential implications to consider?

Is her daughter’s home now considered partially her asset (and vulnerable) because of the addition?

What happens should the money run out?

And, what of the individual who wants to stay in his home and protect it from being used to pay for home health services?

Are he and his assets protected if he transfers the title to his children?

Unfortunately, these questions don’t always get answered before decisions are made and acted on. The rules governing assets and Medicaid eligibility are complex and changing. Don’t wait until the unexpected happens. If you or your family are facing questions around in-place care planning, an experienced elder law attorney can help you navigate estate, real estate, and government benefits eligibility questions.

Petitioning the court for guardianship over another individual is sometimes necessary when the individual in question is not able to provide for his or her own basic needs such as, food, shelter, health care or to manage personal finances. Guardianship may often be avoided if other less restrictive alternatives are available, such as when financial or health care power of attorney documents are in in place.

In New Hampshire, a petition for guardianship will not be allowed unless specific factual evidence is presented to the court and the judge finds the person petitioning for guardianship proved all required facts “beyond a reasonable doubt”.  More information about Guardianship in New Hampshire is available from the New Hampshire Circuit Court Probate Division at http://www.courts.state.nh.us/probate/guardianship.htm.

“My parents have always had separate investment accounts. Dad is being admitted to a nursing home, but mom will be able to keep her account, right?”

The question of whether a parent can keep accounts in their own names often comes up when somebody, one of them, has gone into a nursing home. So let’s just say that the husband goes into a nursing home and the wife is now at home and she’s concerned about the cost of nursing home care and is she going to be able to get her husband on Medicaid. She inherited $80,000 from her mom. She’s kept it in her own name this whole time. People often think that that’s protected because they had it in their own name for years and years.

When there’s a married couple and one goes into a nursing home, it really doesn’t matter whether it’s titled jointly or individually.  For a couple, they’re going to count all countable assets. So if it’s countable, and a bank account is 100% countable, stocks are 100% countable, then they’re going to be part of the Medicaid eligibility consideration. It doesn’t matter if you inherited it.  It doesn’t matter if you just even won the lottery and it’s in your own name, it’s going to be counted.