August 22

Aging in Place

It happens suddenly. A formerly independent family member can no longer navigate life at home successfully 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, 76% of American adults 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), by adding living area to an existing home or creating what is commonly known as an “in-law apartment.” Recent changes in Centers for Medicare and Medicaid Services (CMS) reimbursement policy provide greater latitude for reimbursement of skilled home care than in the past. And, if a veteran or veteran's spouse is in need of care at home, there may be additional resources available.  An advocate from your state's office Office of Veterans Services can help you identify such as resources.

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 considering how best to support an individual's desire to age in place, accurate information and careful planning are key, particularly given the complexity of the interaction between private insurance, Medicare and Medicaid, and the potential impact on one's estate. 

For example, consider the case of an aging parent who needs skilled nursing level of care who is considering selling her longtime home and using some of the proceeds to build an ADU on her daughter’s home, and the remainder of the funds to pay for home services.

Are there any tax implications upon selling the home?

Will her daughter's home now be considered partially her asset (and vulnerable) because of the addition? 

Will using funds to improve her daughter's house be considered a 'gift' and possibly disqualify her for Medicaid in-home benefits in the future, or is there a way to structure the overall plan to document that the mother is receiving a fair exchange for her financial contributions? 

Will she be able to pay her daughter for the personal care services her daughter provides? 

What happens should her 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?

Will transferring the title to his children protect his home? 

Could he later decide to use the equity in the home to pay for caregivers so he can stay home longer? 

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 the many rules and regulations that should be considered and the questions that may arise.


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

Sonia Gianitsis
Renee Lubinski, EA

Administrative Staff
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› Caitlin M. Nelson – Receptionist
› Debra Doyon  Accounting Manager
› Natasha Winslow - Clerk