August 22

Aging in Place

It happens suddenly. A formerly independent family member can no longer successfully navigate life at home without assistance. Is it time to consider moving to assisted living or a nursing home?

Not necessarily.

In fact, according to a recent AARP survey of American adults, 76% of those age 50 and over wanted to remain in their current residence as long as possible. In addition to the emotional and physical stress of moving, there is the comfort of home and the connection of community.

For many seniors, their emotional ties to family and home coupled with the anxiety of a complete change in environment and routines can greatly impact their quality of life and even their life expectancy


Fortunately, there are resources available to support individuals who want to stay home or even live with a family member. As our population ages, the home health care field is booming with an estimated $103 billion spent on home health services in 2018. Another rising trend is the Accessory Dwelling Unit (ADU), either added living area to an existing home or the creation of what is commonly known as an “in-law apartment.” And, recent changes in Centers for Medicare and Medicaid Services (CMS) reimbursement policy provide greater latitude for reimbursement of skilled home care.

So, when does it make sense to pursue at-home care options? And, what of the financial costs of engaging long-term at-home support and/or creating living space in a family member’s home?

When individuals or families are considering how to best support a decision to age in place, accurate information and careful planning are key. Various scenarios can have complex insurance, Medicaid, and estate implications and impact.

For example, consider the case of an aging parent who needs skilled nursing care who decides to sell her home of 30 years and use some of the proceeds to build an ADU on her daughter’s home and use the remainder of the funds to pay for home services.

What are the tax implications of the home sale?

Will the expenditure of funds to build the ADU have an impact on Medicaid eligibility?

Will her daughter, who provides support during the day, be eligible for caregiver reimbursement, and if she wants to pay her daughter, are there any potential implications to consider?

Is her daughter’s home now considered partially her asset (and vulnerable) because of the addition?

What happens should the money run out?

And, what of the individual who wants to stay in his home and protect it from being used to pay for home health services?

Are he and his assets protected if he transfers the title to his children?

Unfortunately, these questions don’t always get answered before decisions are made and acted on. The rules governing assets and Medicaid eligibility are complex and changing. Don’t wait until the unexpected happens. If you or your family are facing questions around in-place care planning, an experienced elder law attorney can help you navigate estate, real estate, and government benefits eligibility questions.


Ann N. Butenhof, CELA
Judith L. Bomster, Esquire
Judith K. Jones, Esquire

Sonia Gianitsis
Renee Lubinski, EA

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