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>> Good evening.

Thanks so much for watching PBS Fort Wayne and LIFE Ahead.

I'm your host Mark Evans.

Of course this show is for adults of all ages and we have a very important topic tonight to discuss some very special guests to discuss it with us.

We're talking about aging in place and growing older at home, which seems to be a more popular choice than folks going into nursing homes or living assisted as long as they can.

So we're going to talk about that and since we are a viewer interactive program, I want to let you know that there are a couple of ways you can contact us with some questions or concerns or some comments we'd love to hear from you.

That's what this show is all about so you can call the number on your screen at two six zero (969) 27 two zero if you'd like to be on the air to ask your question or if you'd like for us to transcribe your question another way is to text.

Oh yes.

That magical way of communicating these days you may text us your question or your concern.

The number is two six zero (969) 27 three zero and when you text us please give us at least your first name and the town or city from where you're calling because we'd like to do a shout out to you and we appreciate that and thank you for watching tonight and being a part of our show.

>> So our guest attorney Heidi O'Dare.

Hi.

>> You're not new to the program.

No, but it's great to have you back.

Thank you.

You are an elder attorney.

>> That's right.

OK, very good.

And then we have a geriatric care specialist Ruth Force and Ruth, you've been on the program before him?

>> I have, yes.

It's been a little while but it's been a little while.

But they have been on yes.

All right.

>> And I remember watching that and you provided some very, very good information.

>> In fact, both of you do want to go ahead and start.

Let's just get down to the skinny of it.

You know a lot of people have decided to age in place and stay at home.

>> What are the main reasons for that?

>> Yeah, I think the number one reason that I find that people want to age in place is the comfort of your own home in your own environment.

We all feel better when we're in our home.

>> We're comfortable in our home.

Memories are in our home.

That's where families have been besides the fact that assisted living nursing homes they do cost money.

People want to save money aging in place saves them some money in that regards just having personal things around you, I mean there's there's nothing to be you know, it's very important.

>> I just think that's the reason why they want to age in place and we're going to talk about some of those costs and how those are covered in that's one of our reasons for Heidi being here and some of the legalities of all this should come to play.

>> Another question for you, Ruth what guidance if someone wants to stay at home, can you provide for someone to stay at home safely?

>> Sure.

I think it is very important for an assessment to be done whether it is through there are so many different local agencies here in Allen County and surrounding counties that can provide assessments for loved ones for in the home to determine their needs, what they're capable of , what they need help with, what different resources can be put in place.

>> Well, since you've talked about that, how does someone determine the need for assistance?

>> Sure.

I you know, I always there's some questions that I always tell people.

Are you asking yourself you're overwhelmed with going through the mail with paying your bills.

Is this overwhelming you do you find that just maybe taking showers is not good anymore?

Your concern for your safety getting dressed is harder.

Maybe doing laundry is piling up the basic tasks that we all take for granted every day become harder as we age.

And if you're asking yourself, you know, maybe I need some help on this or I'm overwhelmed or flustered if family is out of town and you have no one local, it's important I think to get help in the home as well .

You know, and if you have an early diagnosis, early onset dementia or any other, you've got an early cancer diagnosis, Parkinson's, whatever that is.

Maybe it's time to look into what's out there for you sooner than later.

>> And I'm so glad these days we have more resources and people like you to help people along the way with that and Heidi, what programs are really available these days to help pay for this in-home care because I know it's not cheap .

>> No, no.

I mean we always just kind to go through the list of private pay is always an option, you know, which is kind of freeing people don't realize that, you know, you can open up your checkbook and pay for three hours a week of care and it's not horribly expensive.

So private pays an option.

People have a long term care insurance that may be available to cover in-home care and then the VA has a program called the Aid and Attendance Program and then Medicaid can also be an option.

>> Medicaid yes.

So what is the usual wait time for using Medicaid in the home setting?

>> Yeah, I mean this is kind of an interesting change that we're dealing with right now and when you go to apply for Medicaid in a nursing home, you can do that whenever you want to.

But if you want to use the Medicaid waiver program which is the program you would use to pay for either home care or assisted living, you have to be issued a waiver slot and there's a waiting list to get a slot and right now that waiting list is running about a year.

So you really have to be thinking planning ahead if you want to take advantage of those programs.

>> Is that because of so many people requesting the help and we don't have enough staff on the other end to handle what would be some I don't know two or three years ago there was a major budget crisis in the Medicaid program.

You may remember that and it was a reaction to that.

And so the state has said we're going to approve this many slots per year and they kind of stagger throughout the year that they issue them and it's a way of controlling the budget.

>> I know I have a dear sister who is on Medicaid and it took her a year and a half.

>> Yeah.

And she called me crying you but she finally got it.

>> Thank goodness she's being taken care of .

Good.

So Ruth, how does a person or a family member know what services are going to be needed?

>> Mm.

The assessment the assessment is key and if they just reach out to our local area on aging they can also help determine those needs and again the other agencies in town can do the same.

So if someone were to reach out to a home care agency or I get a call that says Hey we're not sure what we need, this is what's going on, this is the scenario and then we just kind of talk that through a little more and connect them with those pieces.

So whether it's the home care or food delivery is delivered meals or is there some durable medical equipment that is needed.

But I think the families make the first that first question is just reaching out and asking .

>> So during this I need those resources.

What what can you expect?

Do you come to the home?

You go to the home and it's a very holistic assessment.

I mean we're wanting to know their support system.

So if you if you were the person I was going to do the assessment on, I would ask you what your support system or your family do you have church members?

Do you have a church family?

What can you do for yourselves ?

Can you bathe you know, can you shower yourself?

Can you dress yourself?

We look at your medications, we look at your diagnoses.

We look at your house for safety aspects.

You know, are there some safety concerns in place?

>> So it's very holistic financial to we need to know in order to help maybe with that Medicaid planning piece just a very holistic assessment and then you get this report and you get all of these recommendations and you connect with all these different area resources through that.

>> And you mentioned recommendations and I'm taking that as the services that could be provided for this person.

>> Yes.

And you touched on that just a little bit a couple of questions ago.

So can you list some of those those services for those who don't know?

>> I'm sure you know, I think it's very important the home health care can be a skilled home health care but that's normally after a surgery or hospitalization.

We have many very good nonmedical home care agencies that can provide the companion and the attendant level of care for your loved one anywhere from a three hour visit to twenty four seven depending on the need you had durable medical equipment, an emergency response system which is still a very big thing to do even Apple watches now can detect a fall but it needs to be put in place if they don't have that a lot of time.

So I'm connecting people with elder law attorneys because they don't have their advance directives drawn up.

They don't have anyone appointed so it can it can be a referral to them as well.

>> Yeah, advanced directives in fact doing this show for so many years off and on we've done several programs advanced directives and I would add I mean you can pay people to help you with your finances if that because that can become an overwhelming task for people.

Yeah.

So there are people that you can get to assist you with those things.

All right.

We've got a text coming in and let me ask you this question, Heidi, before we get into that the requirements God bless our veterans but we talk about Medicaid and then let's talk about veterans as well.

What are the requirements in regard to a person's health to actually qualify for Medicaid or VA help?

>> Well, the VA program is for it's called the Aid and Attendance Program and it's for veterans and their surviving spouses who serve during a wartime period and the health requirement with that is generally you need to have help with two activities of daily living and activities of daily living are, you know, bathing, dressing, medication management, those types of things.

The Medicaid program requires three assistance with three ADLs so assist activities of daily living.

So the VA program you can be a little bit healthier and qualify for that if you had that like war time period service.

>> OK, and I want to talk about assets and income as well in just a minute.

But let's get to Tom from Columbia City who is actually texting us a question if we can bring that up for everyone.

He is asking what are some things someone who is aging at home do to stay socially active to minimize loneliness and isolation?

>> Tom, thank you so much for that text and that's a wonderful question because that loneliness and isolation is huge.

So if you are able to drive I always encourage people if you are a member of a church to participate in church activities.

The local area on aging has different activities as well different outings, group events that you can participate in and go and meet people that way.

Support groups are out there if it's a diagnosis issue and you want support you can be around others with that same diagnosis if you're not driving that's when I would recommend bringing a companion service and the can actually take you to those things.

You know and beyond that they can take you grocery shopping, they can offer you companionship, go for a walk in the park in helps with that loneliness and isolation and you know and I can mention that because they're not for profit and they've actually on the show before but AARP yes, I am a subscriber to them and they actually provide some very good hints to get out and socialize and to even socialize within your home and how to have a little many parties, if you will, and people coming over and you know, doing a monthly thing and just staying in touch with people.

It's so, so important to be engaged socially.

>> Yes.

I just had a client come in and he can't really drive that much anymore and he has taken to he was in a grief group a while ago and he calls the people who were in his grief group just to keep you know, that's his kind of service that he's doing now and it's keeping him socially active.

>> So you just got put yourself out there and get involved in things.

>> Yeah.

And there's some funeral homes that I'm aware of that have programs called something like lift if you will and it's to lift your spirits after you've lost someone and it's also a great way to socialize and network with people.

>> Let's get back while we're going to receive some more calls here and text the requirements in regarding a person's assets to qualify for Medicaid and VA.

>> Yeah, so the Medicaid number is two thousand dollars.

>> You have to have less than two thousand dollars in order to qualify for Medicaid.

That's two thousand dollars in the bank.

>> So that's like total like everything of your life insurance cash value, what's in the bank, what's in your IRA, what's in your 401k two thousand two thousand dollars but that's not a whole story.

Go see an elder law attorney because a lot of times the elder law attorney and a married couple situation through jumping through legal hoops can help you get on Medicaid and protect your assets if you are a single person.

The rule of thumb is we can help protect about 50 percent of your assets so don't let that two thousand dollar number scare you.

The VA is a lot more generous.

It's one hundred and sixty three thousand dollars.

It goes up a little bit every year.

So if your assets not including your house or your car are less than one hundred sixty three thousand, you may be eligible for the aid and attendance program.

Now that's assets what about income income?

>> So the VA is a very strange program which I just do not know off the top of my head.

But the rule of thumb is if your medical expenses are more than your monthly gross income you are going to get a hundred percent of the available VA benefit which the VA benefit might is twenty four hundred dollars for the veteran and about fifteen hundred dollars for the surviving spouse and if you're somewhere less than that the number can go down of what you're going to get from the VA so it just it really varies.

>> All right.

If you're just joining us it is LIFE Ahead here on PBS Fort Wayne and we'd love for you to give us a call or text for the questions regarding pardon me aging in place and growing older at home.

And we have Heidi Adare who is an attorney elder law attorney with us and geriatric care specialist resource.

>> So please give us some correspondence will be more than happy to address your concerns.

>> Let's go ahead and switch over to to Ruth right now.

>> We were talking about this whole Medicaid thing.

Can someone appoint a representative to assess I should say assist with the Medicare Medicaid application or the waiver process?

>> Yes, yes.

Has that done?

There are a variety of elderly attorneys who will help in that process but there are a handful of us out there as well that will do that.

>> Yes.

And I would I'm sorry.

Yeah.

I would add that, you know, the paper gathering requirements to apply for Medicaid are just huge.

There's so much to do and so the elder law attorneys generally are just kind of telling you what to do and instructing you what to do.

But there are people like Ruth and others who you can hire to actually help you through the paperwork side of it.

>> You know, drive them to your bank, call your banker, ask the questions.

Do the things that need to be done and you were talking about the assets and so forth and there's a thing called spend down and could you explain what that is and why that's important?

>> So when you're trying to get to that two thousand dollar level of of Medicaid getting there, it's called the spend out and the spend down could be literally just spending it down, applying once you're down to two thousand dollars.

But elder law attorneys also have other ideas for spending like paying parts of funerals for children and their spouses improvements to your home, doing some gifting that we somehow we can somehow allow you to do so lawyers have a lot more ideas of spending down than just continue to pay bills until you're down to the two thousand dollar mark, OK?

>> All right.

Ruth, what if in the end juxtaposing words here that the in-home care services aren't enough, what happens then?

>> Sure, if in-home services are not enough and not everyone can afford the twenty four seven home Karatz assisted living would really be the next level up prior to a nursing home placement.

But there are a variety of assisted living within our communities.

Some are the Medicaid waiver, some are private pay and I just encourage families and my clients to go and tour them before a crisis occurs.

Do it now or you can really look around.

You can get a gut feeling for what the places like which one are you going to like living and kind of get some more specifics on that because when a crisis occurs nine times out of ten the place you like isn't going to be available.

>> So you know, I'd rather someone pick it ahead of time or at least see but yeah, that's it's going to move that ladder of care and level of care and where you're going.

>> So I would imagine it's very important not only for the patient but their family members or even their caretakers at this time they go as well everybody else.

>> Absolutely.

And are these facilities open to these tours?

I mean they are.

Oh yes.

they are.

>> Yes.

So that when they welcome them.

Yes.

Oh good.

Good, good.

And I would throw out even for someone who is struggling being at home with social with zation they might prefer assisted living.

You know it's you got to just keep reinventing your life even at eighty five years ninety years old you got to keep keep reinventing yourself and being willing to try new things because being around your peers might be something you really enjoy.

>> Oh I would imagine I would imagine sharing stories and they might even bump into somebody you know.

>> Right right right yeah .

We have another text coming in actually it's an offline question.

I apologize.

James is asking Fort Wayne .

He is asking how should I approach the subject of getting help for my parents?

>> It's a very common question.

I very much so.

I get that a lot.

It's hard.

It's difficult.

I mean I you know, my own parents didn't want to think about having help and it's really just a matter of sitting down gently talking with them and just being honest with them about your concerns and maybe bringing someone into sit down and talk with them.

That's not family because I find that a lot of times, you know, they're more receptive to a stranger coming in versus their children and telling them that they need help.

They are more receptive for a stranger.

>> Yes.

Yes.

Because as parents don't want our children telling us what to do right.

Well or maybe expressing we don't want to hear that we're aging well that would be a good way to to approach a parent.

You really need to I just think you need to be honest with them and sit down and just say we're concerned as your as your family, as your son.

I'm very concerned and this is why I'm concerned you know, cite the examples whether it's not paying your bills on time or I don't think you're taking a shower like you used to or maybe the house doesn't look as clean as it used to.

>> Let me pull in a housekeeper for your mom or dad .

>> You know, maybe we can maybe you're not making those meals.

Can we talk to someone about getting some meals in the home for you and just broach it gently but honestly, very honestly and openly?

That's the best way to approach it.

>> It sounds it's not easy.

It's never an easy conversation.

I can almost imagine the fact that I've been there.

>> I know I would add that, you know, you can't it is ultimately up to your parents of what they want to do as long as they're of sound mind and able to make decisions for themselves.

>> And sometimes you just unfortunately have to wait until there's an emergency situation and that is what causes people to be ready to get help.

But as Ruth said, when you're waiting for the crisis, what your perfect path is going to look like may not be available.

So planning ahead and just facing those things early helps everyone and you might just have to shop around a little bit.

>> Yeah, right.

I would probably advise just make sure the choice you made is really the right one, right?

>> That's right.

This is right as it can be.

Yeah.

Let me ask Heidi the estate planning documents that are involved what should the person consider having in place to qualify for these home services?

>> It's just really important to make sure you have powers of attorney somebody to help you with your finances if you can't do that for yourself.

And a health care representative appointed somebody to help you make health care decisions if you can't do it for yourself and then wills are important too.

But honestly the powers of attorney a lack of that really makes it difficult for your family or other support system to to be able to help you would advance directive be a part of that as well?

>> Uh huh, yeah.

And would you please explain what advanced directive is an advance directive really in my view is you naming your health care representative who is going to make health care decisions for you and then you can go on into more detail in that document if you want to give them some guidelines as to what you want your health care decisions to look like.

>> So I've got Mom who has to make a decision.

We need to go to the lawyer.

What do we need to bring with just to make things easier for a lawyer like you?

>> Yeah, the way that we work is if somebody calls in for an appointment we will email or snail mail a questionnaire in advance of the appointment.

Oh, nice.

And if you can take the time to fill that out as best you can, it allows us to just have a really productive first meeting and hopefully have all the spellings of everybody's names who are important in your life in that kind of thing.

>> So that questionnaire is key.

All right.

And if mom or dad is able to come along, they definitely need to be there.

>> Oh yeah.

Yeah definitely.

Yeah.

OK, well how can I pay for family members or can I pay family members to help provide care?

>> You can you can but I would give this warning if Medicaid is something that you want to use at some point they have become very, very picky overpayments to family members and the only way that you can do it at this point is to have a written contract that has been notarized and the services cannot can only be given after the notarized date of the contract and you have to keep very careful logs.

The date the service was done who did the service, what was done and you just have to be prepared to present all of that to Medicaid should you go to apply if you've been paying family members without a contract, Medicaid will treat those as gifts to those family members and it will actually create a Medicaid penalty preventing you from qualifying.

>> Oh well so the written contract at this point is very important and you as a elder law attorney can help someone with the Medicaid process getting involved in that.

>> OK, that's great.

That's what we do.

All right.

Well, we only have about a minute left in the program and I would love to leave our viewers with some parting thoughts if you will, because in the case we didn't cover everything during our questioning.

>> But I'll start with you hiding.

The main thing that I just want to tell people is to not be afraid of the aging process to just go arm yourself with information, talk to people like Ruth to our facilities, talk to an elder law attorney because it really can eliminate a lot of the anxiety if you've got a plan.

>> All right.

I agree with Heidi completely.

I agree with her completely.

I would like to add this with aging in the home with modern technology we're talking about texting.

It is so important with those advanced directives to have a list of all of your accounts, your passwords and how to get in because if there is a crisis in your family needs to be able to get into even if it's an electric company, it's important to do that.

We didn't really touch base on that.

But I think that's an important piece too for aging in place and just having all of that together.

>> But I think families are doing the best they can out there.

I see more and more families involved now versus twenty years ago when I started this.

>> So I love that and ask the questions, be involved, be engaged and seek help.

>> Seek help when you need it.

That is excellent.

Excellent advice.

Both and we truly appreciate you being on LIFE Ahead this evening on this very important information.

>> I think all of us eventually are going to have to probably deal with this particular subject.

>> Yeah.

Yes.

All right, Heidi Adare and geriatric care specialist Ruth Force, thank you so much for being here and we're sure to have you back again.

>> Thank you.

All right.

You're very welcome and thank you for watching and for your calls and your text.

>> We really appreciate it.

And you can also watch this and other LIFE Ahead programs on YouTube and of course at the PBS Fort Wayne website until next time.

We sure hope you have a happy and safe LIFE Ahead