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. For long-distance caregivers, there almost always comes a point in time where families give serious consideration to moving a loved one to be closer to family members or a primary caregiver. This can occur when aging family members are still healthy and able to live independently, following a change in health status or a medical emergency, or even once they are already placed in an assisted living or skilled nusing facility.
There are obviously logistical and psychological challenges in such a decision. This can include deciding which family member they 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 fully think through the financial 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 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 evolve or change rapidly, so it is important to give all of the following questions and factors proper consideration, even if they do not yet apply.
Scenario One: The Preemptive Move
At some point in time, typically both generations (perhaps even three) sit down together and look at the possibility of everyone living in the same time zone or zip code. Even when your loved one is still healthy, this decision may arise because visits are too far apart and the family misses the opportunity to be together on a more regular basis. There are certainly benefits to such an arrangement, but what about the drawbacks and contingencies?
- 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 the specialist in your family member’s present location 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 have 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, many family members tend to think more seriously about moving them closer. This give family the ability to provide support and assistance on more regularly and on shorter notice. They also have an easier time monitoring their loved one’s health and overall situation. Depending on their current status and prognosis, there are a number of possibilities to take into account.
- If your loved one has been living independently, have you or are you considering assisted living? Are there facilities in your area to choose from? Do they meet your standards? What are the costs?
- Do they have a long-term care insurance policy or veterans benefits that can help with the costs?
- 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 making 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 may not qualify in another, or you may find that your area has many more offerings at a more reasonable price. 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 Managed Care/Medicare Advantage/Medicare Part C plans for little or no cost. 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 and a supplement. (Please note: Moving from a Medicare Advantage plan to original Medicare is not always easy or possible. Leaving a service area gives you special enrollment periods, but the options and pricing for supplemental coverage could be much different than expected. For more information, see “Time to Re-Evaluate and Change Medicare Plans."
- Following a new diagnosis or illness, a loved one’s new health status may require a different type of coverage. If they are seeing lots of specialists, a Medicare Advantage plan which was useful “back home” may not be cost effective at this point. Speaking to a SHIP (State Health Insurance Program) counselor through 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 assisted living or a nursing home. Unfortunately, distance often complicates this situation even further. If you are thinking about moving your loved one to a facility where you can be regularly involved in their care without extensive travel or sacrificing your work or daily life, be sure to consider the following factors.
- If your loved one is already in a skilled nursing facility and they are accessing Medicaid, you need to check with the Medicaid office in your state about whether they can transfer 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 the new coverage is 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. 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, is there a different “look back” period 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 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 that surprises are minimal. The overarching questions for the above three scenarios (and any other) will be: Will there be medical and financial consequences to a change of residence? If there are significant concerns, you may want to reconsider such a decision.