©  JACKSON LAW

Home Care Programs

On a daily basis, I meet clients who are feeling the burden and stress caused by the needs of an elderly and/or sick family member. I provide information and develop an action plan with them that is catered to the needs of the family or individual. This is the elder law side of my practice.

“Plan A” is what I call the action plan for my elderly and/or sick clients who want to stay at home, because remaining at home is everyone’s first choice. There are a number of excellent home care agencies available for those who can afford the hourly rate of $20–$25. There is long-term care insurance, which helps pay for home care, assisted living, and the skilled nursing home.  
There are also government subsidized programs that assist my “Plan A” clients who medically and financially qualify. My top five choices are:

  • PACE: Program of All-Inclusive Care for the Elderly

    • Funded by Medicare and Medicaid to help people stay at home, PACE provides services in the home, community, and at a PACE center, which offers van service.

  • SCO: Senior Care Options

    • The SCO program covers all services reimbursable under Medicare and MassHealth, standard for members who are 65 or older. The services include social support, medical support, specialized geriatric care, and respite care for families and caregivers. SCO utilizes a team approach of professionals, including the physician.

  • MassHealth Waiver Program (MassHealth Frail Elder and Community-Based Services Waiver)

    • The Waiver program pays for a certain number of hours per week of professional home care. MassHealth manages the staffing, so the patient’s family does not have to “hire and fire.” To begin the application process for this program, you can contact your local ASAP (Aging Services Access Point). There are 27 ASAPs in Massachusetts. For example, Northampton residents would contact Highland Valley Elder Services.

  • MassHealth PCA (Personal Care Attendant) Program

    • The PCA program is similar to the Frail Elder program. The major difference is that MassHealth does not manage staffing, you do, and MassHealth pays the staffing costs.

  • Aid and Attendance or Housebound

    • This is a home care benefit available to veterans and/or a surviving spouse who require the aid and attendance of another person or who is housebound. It also pays for assisted living. It is a monthly payment in addition to the monthly pension. Applications can be made through the veteran’s counselor in the town/city of the veteran’s residence. Unfortunately, the process takes over a year before the payments begin.


If staying at home is no longer possible, “Plan B” must be utilized. There are numerous “Plan B” alternatives available in western Massachusetts: retirement communities, rest homes, assisted living residences, and skilled nursing homes. Veterans have the Soldiers’ Home, a skilled nursing facility in Holyoke.

On average, people are living longer, but health fails naturally, and a skilled nursing home sometimes becomes the only alternative. FYI: the average stay in a nursing home is 30 months. A skilled nursing home currently costs an average of $370 per day. That is $135,050 per year! That’s $337,625 for the 30 months! Quite the sticker shock. I work with families to develop a Medicaid plan and prepare the MassHealth application so that MassHealth will pay the majority of the nursing home bill. The goal is to get needed care in place and, at the same time, preserve a family’s estate from astronomical nursing home expenses.

I am also an estate planning attorney. I prepare estate planning documents so that in the event of mental or physical incompetency or upon death, probate court and the associated stresses may be avoided. These documents are a different kind of “action plan” and are essential. Good estate planning documents are a gift to you and your family.  
    
I call estate plans “The Big Five”: a health care proxy, in which you name who will make health care decisions for you if you are unable to do so (thereby eliminating any possibility that a court will have to appoint a guardian for you); the advance directive, more commonly known as the “living will,” which empowers your health care agents to make life-sustaining and/or end-of-life decisions on your behalf; the HIPAA authorization, which allows doctors, hospitals, insurance companies, etc. to share  important health care information about you with people you designate; the durable power of attorney, in which you name the people you want to conduct your business affairs (yes, even paying your bills) if you become unable (eliminating a court’s intervention to appoint a conservator for you); and, finally, a will, which will take care of passing on what you have to the people you have chosen and names who will manage that process, your “personal representative.” I cannot emphasize enough how important an estate plan is, whether you are 88 or 18, because “stuff” happens, at any age.

Finally, trusts. It is the sixth document added to The Big Five and is in addition to the will. I only recommend a trust if it is needed for a particular purpose. You do not have to be a millionaire to have a trust. Together we can determine if a trust will serve your best interests now, in the future, and after you have passed away.