It doesn’t have to be a nursing home

MONTICELLO, NY — Call it “The Event.”

Something happened. Maybe you fell and, suddenly, you need a wheelchair, but your house is full of stairs. Maybe you’ve been ill and you’ll need help for months, but you learn that Medicare does not pay for home health care, nursing homes, or assisted living, and will only pay for certain kinds of equipment. 

Paying for long-term care is absolutely a concern for seniors, said M. Cindy Hounsell, president of the Women’s Institute for a Secure Retirement located in Washington, D.C.

No need for panic. 

“If you have an event that changes your life, it can be daunting,” said Lisa Luborsky, regional coordinator for the Independent Consumer Advocacy Network (ICAN) in New York State. ICAN offers free and confidential help in obtaining Medicaid-managed long-term care (LTC) and assists you if you have trouble getting services.

Requiring help with daily activities for a minimum of 120 days qualifies as long-term care (LTC). Knowing your options, and thinking about how to pay for it, “is absolutely something to have in mind,” Luborsky said. 

The majority of ICAN’s clients are over 65, according to David Silva, ICAN program director.

It’s a valuable service. “Sullivan NY Connects has referred consumers to ICAN services since the inception of the... program in 2014,” said Martha Scoppa, NY Connects coordinator. 

Have you had your own “Event,” or are you making just-in-case plans? Here’s the info you need. 

Turning to Medicaid

Medicaid pays LTC costs for 51% of the people who need care, so let’s start there.

Medicaid-managed LTC covers care in the home or at adult day care, and there are reasons to opt for that. It’s cheaper than a nursing home, and you’re surrounded by familiar people and things. That’s where ICAN comes in.

“We help you remain in your community and help to keep you safe in your home,” Luborsky said. 

But maybe you’ve gotten stuck on the word “Medicaid.” It’s just for people with nothing, right? What if you’re married?  What if you have a house? A car? 

“Medicaid is based on your monthly income and resources,” Luborsky said. Your house or car are not counted. “We can assist anyone with Medicaid eligibility who is looking to enroll.” 

For those in New York State, ICAN will walk you through the process, starting with the Medicaid assessment and explaining any financial adjustments that need to be made. “You don’t know [if you qualify or not], so don’t rule yourself out,” Luborsky said. 

For instance, if your monthly income is too high but you need Medicaid’s help with your medical bills, the extra income is treated like an insurance deductible; after that is used up, Medicaid will pick up the remaining costs. (Ask ICAN for advice, or see www.bit.ly/TRRmedicaid.)

If problems arise, ICAN can act as an advocate if the patient disagrees with a decision. Scoppa said the program is “a very important resource for Medicaid recipients with long-term care issues and complaints.”

Above all, don’t despair.

Even if Medicaid isn’t an option just yet, there are other programs and insurance plans. No matter how you do this, planning is critical, even if all you do is talk to someone like Luborsky, who understands the system, can guide you through it and send you in the right direction.

ICAN “is a vital program that helps so many people that would fall through the cracks otherwise,” said Lise-Anne Deoul, director of aging services at Sullivan County’s Office for the Aging. It helps “in navigating the sometimes difficult maze of Medicaid eligibility and accessing the services they need to maintain themselves safely in the community.”

Dealing with the process on your own can be intimidating, especially if you’re juggling new responsibilities or your own illness—but you aren’t alone. “We’re here to help,” said Luborsky, “to advise, and make sure that people remain safe in community.”

For more information, contact ICAN Coordinator at Legal Services of the Hudson Valley Lisa Luborsky.

Call 845/331-9373 or visit www.lshv.org. There is a satellite office in Monticello; call the main office for an appointment.

Contact Women’s Institute for a Secure Retirement (WISER) by calling 202/393-5452 or visit online at www.wiserwomen.org.