What should we be wary of in our search for an assisted living apartment?
Dear Senior Legal Line:
My wife has dementia and we want to sell our house and move into an assisted living apartment. What should we be wary of in our search and do you have any tips?
Assisted living apartments are increasingly popular with older adults who wish to live as independently as possible. According to the Star Tribune (“Speak Up, and Risk Eviction”, November 15, 2017), with 65,000 beds, assisted living facilities serve more than twice as many older adults as nursing homes in Minnesota. This popularity, however, has been marred by some bad things that have happened to older adults. This article aims to provide some tips to help you avoid bad things.
First, the go-to place for help in finding assisted living facilities and getting answers to assisted living questions is the Senior Linkage Line (1-800-333-2433). They have aging experts who can help answer questions, and provide you with the important assisted living verification code that you will need when shopping around for an assisted living facility. The verification code is needed before you can sign a contract with an assisted living – it shows that you have found out the basics about assisted living facilities. The Minnesota legislature requires this as a protection to older adults.
Because your wife has dementia, you need to choose an assisted living that will be able to provide for your wife’s needs. As a part of that, you need to know if the facility will accept payment from Medical Assistance, because most people will need Medical Assistance at some point to pay for their long term care. The Medical Assistance program that pays for care in an assisted living facility is called Elderly Waiver. Some potential traps with Elderly Waiver are:
- Some facilities do not accept Elderly Waiver. Some only accept Elderly Waiver until you privately pay for care at their facility for a number of years.
- Because facilities lose money on Elderly Waiver beds, most facilities only have a small number of them. Don’t rely on the fact that one will be available when you need one (e.g. when you’ve spent down your assets to the Medical Assistance eligibility limit).
- Elderly Waiver generally does not pay the rent (also known as room-and-board charges). The only program that pays for Elderly Waiver room-and-board is the Group Residential Housing (GRH) program and it is for low-income residents (gross income of $893/m). Everyone else on Elderly Waiver has to pay their own room-and-board, plus spend down their income on medical bills and services. The rules for Elderly Waiver are complicated because there are three different categories of income levels.
- Under the Elderly Waiver rules, in some circumstances, the community spouse (the one not on Medical Assistance) may have to contribute some of his/her own income towards the spouse’s costs at the assisted living. In contrast, a community spouse never has to contribute income towards the costs of a spouse in a nursing home.
- Timing of applications and care plans are crucial for Elderly Waiver. Unlike a nursing home, eligibility for Elderly Waiver doesn’t start when you’ve spent down your excess assets. It starts when the county social services department has approved your care plan and your application. The care plan is put together after you are screened by a social worker and a public health nurse. The care plan is good for 60 days. If the application isn’t approved within those 60 days, you’ll have to get a new care plan, which can result in a gap of time where you have to privately pay for care until the new care plan is in place. This is a big difference compared to a nursing home, where eligibility can go back 3 months before the date of your Medical Assistance application if you were eligible in those 3 months (e.g. if you spent down your assets to the eligibility limit 3 months prior to the application). This means that nursing home bills can potentially be paid 3 months prior to the application date. Elderly Waiver has no such retroactive payment.
- Later, when you are a resident of an assisted living facility, don’t be too quick to give up the fight if you get a notice to vacate. Assisted living facilities need to give proper notice before they force a resident out. The rules are complicated. Many times the resident does not get the proper notices. There often needs to be two notices (sometimes they might be combined): one that follows Minnesota landlord-tenant law and one if services are terminated that provides other information, such as your right to contact the Ombudsman for Long Term Care. If the notices lack something, you have a stronger opportunity to negotiate for what you want and/or defend yourself in eviction court.
Similarly, if the assisted living facility is saying that your needs can’t be met or you have behavior issues that can’t be handled, you may wish to ask for a reasonable accommodation if you can tie the alleged behavior to a disability. Unless the accommodation causes an undue burden or causes a fundamental change in how the facility operates, the facility is supposed to try the accommodation and allow you to stay.
Before moving to an assisted living facility, talk with Senior Linkage Line, and if feasible, talk with an elder law attorney to do some long term care planning. Find out as much as you can about the facility. Check the facility’s license and see if complaints have been made about it. What happens when you run out of money to pay? Do they take Elderly Waiver? Do they have Elderly Waiver beds? How many? Would you have to transfer to a smaller unit in order to use Elderly Waiver? What services can be provided? Can you bring in services? Take a tour. Don’t be shy in asking questions. Don’t sign anything until you understand and agree with it.
Senior Legal Line is a legal question and answer line for Seniors.
The column is written by the Senior Citizens’ Law Project. It is not meant to give complete answers to individual questions. If you are 60 years of age or older and live within the Minnesota Arrowhead Region, you may contact the Legal Aid Service of Northeastern Minnesota with questions for legal help by writing to: Senior Citizens’ Law Project, Legal Aid Service of Northeastern Minnesota, 302 Ordean Bldg., Duluth, MN 55802. Please include a phone number and return address. To view previous articles, go to: www.lasnem.org. Reprints by permission only.