Return to Table of Contents
If the individual is living at home, it is likely her or his strong wish to remain there. You should explore what financial programs and services are available to effect this goal.
What are some financial programs available?
- Homestead and home heating tax credits - current and back yearsWhat types of services might be available to allow the individual to remain in her or his home?- Deferrals of special assessments
- Hardship reduction in tax assessment
- Emergency needs, e.g., for furnace replacement
- Reverse equity mortgages
- Home sharing
- Chore services, including heavy cleaning and yard workAside from securing appropriate benefits and services, what should I do?- Home repair, weatherization and remodeling
- Homemaker, including housekeeping, meal preparation, and shopping
- Home delivered meal
- Personal care
- Home health care, hospice care
- Telephone reassurance and friendly visitor
- Respite care
Make sure the individual's homeowners insurance policy remains paid up. If there is an outstanding mortgage, make the monthly payments. Check to ensure the locks on doors and latches on windows are secure.
Do I have authority to refinance the mortgage or apply for a reverse equity mortgage?
A conservator, but not a guardian, has that authority with court approval. You could, however, petition the court for a protective order to accomplish those goals.
What if I feel the individual can no longer safely remain in his or her home?
Discuss the situation with the individual, if possible. Lay out choices available. You might want to broach this subject before the need arises; there may be waiting lists for certain housing alternatives.
What housing options might be available?
- Apartment in private buildingWith whom could I consult about the appropriateness of options?- Congregate housing
- Life care facility
- Adult foster care
- Home for the aged
- Nursing home
You might speak with staff at a local aging organization, an adult services worker at the Family Independence Agency, a hospital discharge worker, or an employee of Community Mental Health.
Although a number of people can provide advice, the decision is yours.
Might subsidized apartments be available?
Yes. There may be government subsidies available. Under these programs, the individual pays a set percentage of her or his income as rent.
What is adult foster care?
Adult foster care is a type of residence offering room, board, supervision, and sometimes personal care, for a monthly fee.
Are there different types of adult foster care homes?
Yes. There are family homes, small group homes, large group homes, and congregate homes. The difference depends on the number of adults living in the home, and whether the owner of the home lives there.
What should I do upon a change in the individual's residence?
It is important you notify the court. It is your duty to do this within 14 days of the move.
If the individual needs nursing home care, how do I choose a home?
You may want to start by getting a list of nursing homes in your county or area. Contact the local department on aging.
Do all nursing homes provide the same services?
No. Some homes only provide basic care, while others offer both basic care and skilled care.
What is the difference between basic care and skilled care?
Basic care is for individuals who need assistance with daily life activities, such as dressing, bathing and eating.
Skilled care can only be provided by, or under the supervision of, doctors and licensed nurses. It may include administration of drugs, diagnostic tests and rehabilitative services.
How do I decide upon a home?
First, check which homes have available beds. Consider the proximity to the individual's friends and family. Next visit one or more homes to get an impression of the cleanliness, ambiance, activities, and quality of care. Ask yourself if this is a place where you would feel comfortable living.
If a home has beds available, must it accept an applicant?
No. Unfortunately, nursing homes can refuse to admit an applicant currently eligible for Medicaid. And although the practice may not be legal, some nursing homes request proof an individual has sufficient assets to remain a private pay patient for a period of time.
Under federal law, a nursing home cannot require an individual or a "responsible party" to agree to pay the private pay rate for a specific period of time before applying for Medicaid. Such agreements are known as duration of stay contracts.
A home participating in the Medicaid program is not permitted to evict a present resident if she or he becomes eligible in Medicaid.
May I sign the nursing home admissions agreement on behalf of the individual?
Yes. But be careful. Read the admissions contract thoroughly. On the signature line, cross out any reference to "responsible party" and sign only as “guardian."
You should add a statement to the contract, "I sign as guardian and I only agree to pay any nursing home expenses from the individual's funds, not from my own funds."
Does signing the admissions agreement as guardian obligate me to pay anything out of my own pocket?
No, not if you make clear on the contract you are signing only as guardian.
What rights does an individual in a nursing home have?
Both federal and state law provide a long list of rights of nursing home patients. These include the right to:
- Dignity, and safety from harmWhat is my role as guardian?- Appropriate care
- Information on one's condition and treatment
- Freedom from unnecessary restraints
- Privacy in communication
- Notice of room or roommate changes
- Complain, without fear of retaliation
As guardian, you can exercise some of the individual's rights. You have an obligation to see other rights are not violated. To help accomplish these goals, it is useful to visit the individual often and to advocate with staff.
May I rely on the nursing home to see the individual's needs are met?
No. You have an important role to monitor the quality of care and scope of services the individual is receiving. And it is your decision, not the nursing home's, whether the individual remains a resident at the home.
Are there other resources to help in selecting and monitoring nursing home care?
Yes. Citizens for Better Care, a statewide advocacy agency, has an excellent book and a number of pamphlets on long term care issues. You can also find detailed information on each nursing home on the internet at www.medicare.gov.
What should I do before choosing a specific residence?
Before making any final decision in changing a residence, visit the prospective setting. Have the individual visit to gauge his or her feelings. Be sensitive to the tremendous upheaval any such change brings.
Medicare is a federally-funded program that covers part of the cost of hospital and doctor care. People are eligible if age 65 or older, or permanently disabled, or receiving kidney dialysis.
Some services, such as annual checkups, routine foot care and hearing aids are not covered at all by Medicare.
There are both deductibles and co-payments for covered services. A premium is deducted each month from the individual's Social Security check.
When should application for Medicare be made?
Contact the Social Security office a month before the individual turns 65.
May a doctor charge a Medicare beneficiary any amount?
No. There are strict limits to the amount a doctor can charge.
A doctor who accepts assignment will only charge what Medicare considers reasonable. He or she bills the patient for any deductible and coinsurance, and collects the balance directly from Medicare.
What if a doctor does not accept assignment?
The patient must pay the bill. Medicare will reimburse the patient for the reasonable charge.
Do I have to complete paperwork to claim benefits from Medicare?
No. Federal law requires the doctor to complete the paperwork. You will receive an Explanation of Benefits from Medicare, showing what Medicare has and has not covered.
Does Medicare cover long term care?
Medicare covers skilled nursing home care for a limited time, and only in certain circumstances. Medicare covers no basic care.
Medicaid does cover both skilled and basic care.
What is Medicaid?
Medicaid is a program funded jointly by the federal government and Michigan, administered by the county office of the Michigan Family Independence Agency. Eligibility depends on an individual's age, marital status, income, assets, and in some cases, amount of medical bills. Eligibility is re-determined once a year.
There are relatively small co-payments for some services. Reimbursement is always made directly to the health care provider.
Are there special Medicaid eligibility rules if an individual in a nursing home has a spouse at home?
Yes. There are complicated rules to prevent spousal impoverishment.
If an unmarried individual is on Medicaid, will all of his or her income go to the nursing home?
No. He or she can retain $60 a month for personal needs.
The individual can also have $2,000 in the bank and still be eligible for Medicaid.
Does an individual have to sell his or her home to be eligible for Medicaid?
No. An individual’s home is an exempt asset, and is not considered in determining eligibility.
Will an individual who receives Medicaid have to pay money back?
Under federal law, each state must have a system of estate recovery. After a recipient's death, the state may claim part of the individual's estate as repayment.
Michigan had not implemented the law. There is no estate recovery in Michigan at present.
Can an individual be enrolled in both Medicare and Medicaid?
Yes.
Are there special Medicaid eligibility rules for people enrolled in Medicare?
Yes. Depending on an individual's income and assets, Medicaid may be available to pay the Medicare monthly premium, or the premium plus Medicare deductibles and co-insurance.
What are some other resources that can help with medical expenses?
- Veterans HospitalWhat benefits are available through a Veterans Hospital?- Emergency Pharmaceutical Program
- Private Insurance
A veteran can receive hospitalization and outpatient care. The VA also contracts with nursing homes for long term care. Contact the Veterans Administration for more information.
What is the Michigan Emergency Pharmaceutical Program for Seniors?
This program, known as EPIC, is available to individuals age 65 or older who are relatively low income and have high prescription costs.
Where can I find out about the Emergency Pharmaceutical Program?
Contact your local Area Agency on Aging for more information.
If the individual has been paying premiums for private insurance, should I continue to pay?
If the individual does not qualify for Medicaid, and the policy seems like a good value, consider continuing the insurance.
You may have to complete the paperwork to make a claim for benefits under the policy.
Return to Calhoun County Courts Home Page
Last Updated 6-18-01
Send your comments, questions and suggestions to Phil Harter at 161
E Michigan Avenue, Battle Creek, Michigan 49014 or
e mail to pharter@calhouncountymi.gov