These days, family members are often scattered in various cities and states throughout the country. This poses a serious challenge when a loved one requires increased care or assistance. There almost always comes a point in time when long-distance caregivers give serious consideration to moving their loved ones closer to them. This can occur when aging family members are still healthy and able to live independently, following a sudden change in health status, or even once they are already living in an assisted living or skilled nursing facility.
There are obviously logistical and psychological challenges in such a decision. This can include deciding which family member the senior should move to be close to and whether or not this family member is willing and able to meet their loved one’s care needs. However, there are even more significant factors to take into account. Sometimes families do not think through the financial, legal and medical implications of such a move. It is important to consider whether it will cost more for a loved one to live and receive quality care in a different city or state, and these expenses are not always obvious.
Let’s look at some possible scenarios to see what factors might influence such a decision. Keep in mind that these situations can change rapidly, so it is important to give all of the following questions and factors proper consideration, even if they do not apply yet.
Scenario One: The Preemptive Move
At some point in time, multiple generations within a family may sit down together and look at the possibility of everyone living in the same time zone or zip code. This discussion may arise when your elders are still healthy, because visits are few and far between. There are certainly benefits to such an arrangement, but what about the drawbacks and contingencies of moving your elders closer to you?
- What is the availability of primary care physicians (PCPs) in your area?
- Do available PCPs routinely accept new Medicare patients? Check with your own physicians to see if your family member might have preference in being admitted to their practice.
- Are there particular specialists that your family member must have access to? Even if your loved one is still living independently, they may have a chronic disease or two that needs more specialized monitoring or attention.
- Does your family member’s current PCP or specialist have any recommendations for colleagues near you?
- Does your loved one still drive? If not, or if they lose this ability, how will they access transportation? What are the costs for the bus system, subway, cabs, etc.?
- What are their expectations in terms of your involvement in their health care and medical issues? Do they want you to accompany them to physician visits, or are they used to doing these things themselves? They may appreciate the opportunity to have you more involved. However, you may see this move as a way to limit the time you need to devote to long-distance travel, not an opportunity to set up a whole list of new responsibilities and obligations!
- On the other hand, are you assuming they will help you with child care, babysitting or similar tasks?
- Be clear about boundaries before entering this new situation. Will you be having family meals or gatherings on a regular basis, or will you be taking a “live and let live” approach?
- If they are going to live with you, will they share expenses?
- Do they have a houseful of furniture and personal belongings that they will have to move? Are they open to downsizing? How do they plan on moving their things? How much will this cost?
Scenario Two: The Reality Check
After a loved one experiences a significant change in their health status, family members tend to think more seriously about moving them closer to provide support and assistance more regularly and be available on shorter notice. This arrangement also allows for easier monitoring of a loved one’s health and overall situation. Depending on a senior’s current status and prognosis, there are a number of factors to take into account before making a decision.
- If your loved one has been living independently, can they continue to do so safely? Has the family considered assisted living? Are there facilities in your area to choose from? Do they meet your standards? What are the costs?
- Does your loved one have a long-term care insurance policy or veterans benefits that can help cover the costs of housing and/or care?
- If they have a limited income, does your community have subsidized or senior housing for which they might be eligible? What is the waiting time? Should you be filling out applications now, even if the move is more than a year away?
- What is the availability of home care services in your area? Keep in mind that rates and sliding scale fees for personal services can vary greatly from one state or area to another. A person who was eligible for Medicaid in one state will need to reapply in their new state, and they may not qualify. Ask questions! Do not assume that what is available for them now “at home” will be transferable once they change residences.
- What kind of health insurance do they have now? Areas with large concentrations of seniors often have reasonably priced Managed Care/Medicare Advantage/Medicare Part C plans. If you move your loved one to a rural area or a place with limited choices, you may find that their health insurance expenses will rise because they need to have original Medicare (Parts A and B) and a supplement (sometimes referred to as Medigap). (Please note: Moving from a Medicare Advantage plan to original Medicare is not always easy or possible. Leaving a service area begins a special enrollment period, but the options and pricing for supplemental coverage could be much different than expected. For more information, see the article “Time to Re-Evaluate and Change Medicare Plans.”
- Following a new diagnosis or illness, a loved one’s health status may require a different type of coverage. If they are seeing lots of specialists, a Medicare Advantage plan that was useful “back home” may not be cost effective at this point. Speaking to a SHIP (State Health Insurance Program) counselor at your local Area Agency on Aging or senior center may be a good place to start. The counselor can give good basic information about plans that are available and projected costs.
Scenario Three: The Facility Move
Many families find themselves balancing life at home and caring for a loved one in an assisted living facility or a nursing home. Unfortunately, distance often complicates this situation even further. If you are thinking about moving your loved one to a facility nearby where you can be regularly involved in their care without extensive travel or disruption to your work or daily life, be sure to consider the following factors.
- If your loved one is already in a senior living facility and they are accessing Medicaid, you need to check with the Medicaid office in your state about whether they can transfer to a new facility and automatically and retain this coverage. Your family member will have to qualify for Medicaid all over again in their new state of residence, and this may involve paying out of pocket for some time before they are approved. You may be reimbursed retroactively, but it might not amount to much. Medicaid regulations vary from state to state, so be sure you understand any differences between programs. It may be wise to contact an elder law attorney just for an informational session.
- If they must reapply in their new state of residence, are there different asset and income limits for Medicaid eligibility? What are the differences in coverage and benefits between the state programs?
- If you are taking someone out of an assisted living or continuing care community, are there deposits that were paid that are nonrefundable? Furthermore, are there any contracts that might interfere with a move?
- Are there similar facilities in your area that only charge monthly fees and do not require another buy-in or down payment? (These monthly fees may be higher than what the individual was paying before.) Can your loved one afford such fees?
- If your loved one has Alzheimer’s, dementia or another serious condition, will they be able to mentally, physically and emotionally handle a move? Will they require specialized transportation? How much will it cost?
- Thinking more long term, what are the estate tax and inheritance laws in your state compared to where your family member lives now? If they are considerably different, will your loved one need to reevaluate and update their estate plan and other legal documents? Are there any reputable elder law attorneys in your area to assist with this? What do they typically charge?
There can be many advantages to having a care recipient live closer to family, but it is important to research some of the financial, medical and legal implications before making a commitment. This will ensure that the transition goes as smoothly as possible and minimize the likelihood of surprises. If there are significant concerns, you may want to reconsider such a decision or proceed very carefully.