Aging in (the Right) Place

Your elderly dad has started wandering and forgetting to turn off the stove. Your mom is having trouble bathing and preparing her meals. “If they’re not succeeding at home, you’re now thinking, ‘Where do we go from here?’” says Patrick Curley, an elder law attorney based in Wakefield.

If your loved one needs more care than you, or a private caregiver agency, can provide—and assisted living isn’t enough—it may be time to consider a nursing home. But what do you need to know upfront?

Start with a free consultation with your local elder service agency, says Curley, and speak with a qualified elder law attorney as soon as possible. “It’s best to talk to the attorney while that loved one still has capacity,” he says. “If you wait until all the crises have already happened, we can still help, but it’s harder and it’s more expensive.”

The cost for nursing home care is steep, and it largely isn’t covered by Medicare, so you’ll need to determine how to pay for it. “Nursing homes in Massachusetts are generally between $15,000 to $22,000 a month,” says Steven M. Cohen of Rubin and Rudman in Boston. “Are you one of the few people who can afford to pay for that level of care?”

If not, speak with your lawyer about applying for MassHealth, Massachusetts’ joint federal-state Medicaid benefits. “Families sometimes make this assumption that their loved one cannot qualify for MassHealth Medicaid,” says Curley. “Maybe they heard from cousin Eddie or their mail carrier, someone at the bank, who told them, ‘Oh no, you’ll never qualify.’” 

That’s not to say there couldn’t be complications while applying. “You have to prove that you haven’t made any financial gifts in the last five years,” Cohen says. “Sometimes they put their house in an irrevocable trust that might make them disqualified for Medicaid. Sometimes they paid for a granddaughter’s wedding or something innocuous, where no one is really thinking of it as a ‘gift,’ but Medicaid will.” A good elder law attorney can show you how to navigate such issues while protecting the assets of the spouse still living at home. 

Choosing the right nursing home is often a matter of personal choice, including that of your loved one. Where do they want to move to? What community do they want to live in? Ask acquaintances about their experiences and speak with others whose relatives reside at the facilities you’re vetting. Assess the quality of care today, not in the past. “For all you know, it may not be the same place,” says Curley. “What might have been family-owned three years ago may now be a corporation out of a different state.”

Compare rankings at medicare.gov, but take them with a grain of salt, Curley adds. “Just because you get a 5-star rating on the website doesn’t mean that it’s perfect, and just because you get a 3-star rating doesn’t mean that it might not be the best place for you. But it’s a good starting point.”

Cohen urges his clients to hire a care manager—a social worker with an inside knowledge of local facilities—who can not only make suggestions but help expedite admission if there’s a waiting list. “If I was needing to put my parents in a nursing home, that would be my first call,” he says.

An attorney can also improve your chances of securing a spot. When hospital staff told a client of Curley’s that only one bed at one nursing home was available, Curley helped the family lock down an additional night’s stay at the hospital. A room at a different nursing home, closer to the family, opened up the next day.

If possible, tour several facilities and pay special attention to staffing. “It’s not the chandelier that matters. It’s the caregiver,” Curley says. “Don’t judge purely on decoration, because at 9 p.m. on a Monday night, it’s not the chandelier that’s going to help.”

Red flags can include bad smells, stained clothing and “people left unattended in the hallways who appear to be overmedicated and restrained,” Cohen says. 

Before you sign, let your attorney review the contract. Add “power of attorney” or “health care agent” after your name, or you could end up personally liable for the expense. And beware of arbitration clauses that prevent you from suing the company. “I would just make a giant X mark right through it,” Curley says. “Many families don’t know better … and then God forbid there’s an accident or a harm to their loved one and they find out they can’t go to court.”

“This is such a big, important choice,” says Cohen. “I mean, look what happened during COVID. … Your loved one’s last months or years should be good ones.”