Site Map Basic Needs Populations

Health
& Illness

Legal MGH
Resources 		Reference Newsletter Excellence Every Day

   

 

Staff Access
Basic Needs
Basic Needs

Housing

Long Term Care & Housing With Services

 

www.maseniorcare.org is a website that provides general information about the long term care services described here, as well as information on ways to access these services. Their website provided much of the information used to create this webpage.

Decision Making/SNF Diversion

Options Counseling provides seniors over 60 and people with disabilities of any age with information they need on long-term care services and supports in order to live independently in the community. Options Counselors can help develop a long-term care plan and connect you to options to remain in the community. They are available to meet in-person and by phone or email.

Options Counseling is a statewide free service through regional Aging and Disability Resource Consortia (ADRC).

Options Counselors frequently provide assistance with services such as the following:

  • Housing
  • SHINE Medicare Counseling
  • Medical Transportation
  • Options for people over-income for Home Care
  • Medical Transportation or Assistance Programs

Those are some examples, but the main idea is that they can provide answers when people have questions about aging or disability. They can also connect people to help and community resources.

To connect with an Options Counselor, contact your regional ADRC agency: http://www.mass.gov/elders/docs/adrc-member-agencies.pdf

For more information: http://www.mass.gov/elders/service-orgs-advocates/options-counseling/ and Options Counseling Provides Answers on Aging and Disability Options- MGH Community News, February 2019

Also see: Adult Children & Inheritance- Helping Elders Come to Terms with Spending Savings on Care - MGH Community News, October 2016

 

Continuing Care Retirement Communities (Also called "Life Care Communities")

Continuing care retirement communities (CCRCs) combine independent retirement housing, assisted living and nursing facility care, usually on one campus, to allow a person to have their current and future care needs met at one location. As a resident's needs change, he or she can choose from among the range of services offered.

See also: Consumer Protection Issues for Massachusetts CCRC Residents

 

Skilled Nursing Facilities

Nursing facilities - or nursing homes as they are more commonly known - provide both long term care for frail elders, the disabled and the chronically ill and short-term care for individuals who have been hospitalized and need a period of medical monitoring and/or rehabilitation before returning home.

Compare Long-Term Care Costs Across the Country

  (For short-term rehab stays see:  Health & Illness/Rehab-SNF, Subacute and Hospital-Levels)

Search for or Compare SNFs:

 

 


 

Paying for SNF

Most people pay privately for ongoing nursing facility care until they qualify for Medicaid/Masshealth. Long-term Care Insurance policies and Medicaid (for Long-Term Care) are the main sources of payment for ongoing care in a nursing facility. Some veterans and surviving spouses may qualify for assistance through the Aid & Attendance benefit.

Medicare only pays for care in a skilled nursing facility under certain circumstances (if needs skilled care and generally only after a qualifying 3 day hospital stay, though there are some exceptions to this such as under Accountable Care Organization contracts), and only for a short period of time (20 days full payment, and reduced payment up to 100 days - more information on our Medicare page). If one has certain high-benefit Medigap plans AND remains at the skilled level of care (not just custodial care), Medigap may offer somewhat more extensive coverage for as long as 1 year.

Coping with the transition to a SNF

The transition to a skilled nursing facility for long-term care is often difficult for the patient and family alike.  There are a number of articles and books available to help patients and families cope.  Here are a sampling.

SNF Residents' Rights

  • Long-Term Care Ombudsman - MA office

     

  • Federal Nursing Home Regulations were revised in late 2016
    • Fact Sheets/Issue Briefs from Justice in Aging
    • Nursing Home Regulations Revised - MGH Community News, October 2016
      • Fact Sheet: Why the Recently-Revised Nursing Home Regulations are Vital for Nursing Home Residents - Justice in Aging
      • Summary of key components:
        • Limiting Facility’s Ability to “Dump” Resident at Hospital: In an effort to evade transfer-discharge requirements, some facilities “dump” residents by refusing to readmit them from hospitalizations. To address the problem, the new regulations explicitly require a facility to follow the transfer-discharge procedures when the facility claims that a hospitalized resident cannot return to the facility.
        • Improvements to Involuntary Transfer-Discharge Procedures: The new regulations specify that transfer-discharge for non-payment is inappropriate when the resident has submitted necessary paperwork to a third-party payor (such as Medicaid), and that payor is now evaluating the claim for payment. Also, facilities now will be obligated to send a copy of each transfer-discharge notice to the state’s long-term care ombudsman program, which is available to advise the resident.
        • Pre-Dispute Arbitration: Currently, many nursing facility admission agreements include provisions obligating the resident to have disputes adjudicated through private arbitration. Such “pre-dispute” arbitration agreements were originally going to be prohibited under the new regulations; arbitration agreements would have been allowed only when the events at issue occurred before the arbitration agreement was signed.  (See accompanying story) CMS, under the Trump Administration, has reversed course,and has filed language that would revise the regulation to allow facilities to obtain arbitration agreements at admission.
        • Antipsychotic Drugs:  Many residents with dementia are inappropriately given harmful antipsychotic drugs, despite strong current federal rules. The new regulations water down existing protections by folding antipsychotic drugs into a broader category of psychotropic drugs, and moving them from quality of care regulations to pharmacy services.
      • Selected Issue Briefs (Justice in Aging) - See All of the Issue Briefs.
        • Visitation Rights discusses a resident’s rights to receive visitors, and the limited circumstances under which restrictions are allowed, emphasizing the important role of resident choice. Key points:
          •  The revised nursing facility regulations affirm the rights of residents to receive visitors of their choosing at the time of their choosing, and require the facility to provide immediate access to the resident. Access to spouses and domestic partners now specifically includes same-sex spouses and domestic partners.
          • Residents also have the right to deny or withdraw consent for visitation of family members, other relatives, and other visitors at any time.
        • Rehabilitation discusses how rehabilitation services are required to be provided and outlines the important consumer protections conveyed through Jimmo v. Sebelius.
          • The Jimmo v. Sebelius settlement firmly rejects, as inconsistent with the Medicare law, nursing facilities’ frequent claims to residents and their families that Medicare will not pay for additional days of care when the resident has “plateaued” or “is not improving.”
        • Return to Facility After Hospitalization discusses federal law regarding bed hold rights for residents. Highlights include:
          • Federal law also establishes a resident’s right to return to the facility even if a bed hold period has been exceeded, or if the resident did not have a bed hold. The regulations specify that the resident can request a transfer/discharge hearing if the facility refuses to accept her back. (This right applies to residents eligible for Medicare or Medicaid coverage of their nursing facility care, but not to residents who would be paying privately when returning from a hospitalization). The right only applies to residents who continue to require nursing facility services.
          • Under this right, the resident can return to his or her previous room, if available. Otherwise, the resident must be admitted to the next available bed in a semi-private room (without requiring men and women to share rooms).
          • Where a facility believes that it has grounds for an involuntary transfer/discharge the resident should be allowed to return, with the facility having the right to initiate the transfer/discharge process, and the resident having the right to appeal.
        • Quality of Care outlines the specific care practices that will enable residents to achieve their highest level of functioning and prevent decline.
        • Grievances and Resident/Family Councils covers residents’ rights to file complaints and the federal laws regarding the procedures facilities are required to follow in addressing grievances. 

  • FAQ: What to Do When a Nursing Facility Tries to Force Payment from Friends or Family, Justice in Aging, 9/23
  • 25 Common Nursing Home Problems and How to Resolve Them (National). Also see related newsletter article, January 2019
  • Long-Term Care: Regulations and Resident Rights- Mass Bar Association, 2018
  • Rights of Nursing Home Residents -Margolis & Bloom (Massachusetts)
  • Resident's Rights Fact Sheet - The National Consumer Voice for Quality Long-Term Care (National)
  • Involuntary Transfer/Discharge Rights - MGH Community News, September 2013
  • Nursing Home Residents' Rights for the LGBT Community - MGH Community News, September 2013
  • Leave of Absence Should Not Jeopardize Medicare Coverage - MGH Community News, December 2010
  • State Orders SNFs to Stock Narcan, Train Staff to Care for Patients with Addiction- MGH Community News, November 2016

SNF Policy Issues

SNF Trends/Best Practices:

SNF Program Highlights:

 

Assisted Living Facilities  

Assisted living residences are for older people who no longer feel comfortable or safe living alone, but do not need the kind of 24-hour nursing and medical care provided by nursing facilities.

Assisted Living in Massachusetts: A Consumer’s Guide - MA Executive Office of Elder Affairs

What is Assisted Living? - A Presentation by Emily Meyer of MassALFA
Sponsored by the CRC

Compare Long-Term Care Costs Across the Country

 

Assisted Living Facility Locators

     

    Assisted Living Subsidies and Other Payment Sources: 

    • GAFC (Group Adult Foster Care) and SSI-G

    • Elder Service Plans (ESP)- also called the Program for All-inclusive Care for the Elderly (PACE) - Seniors with MassHealth whose care needs would qualify them for nursing home care may choose to get their care through a Elder Service Plan.
      • ESPs are managed care plans that provides additional service not typically available through MassHealth. Members must use ESP-participating physicians and related providers. MGH currently does not participate. So patient would need to decide whether to give up MGH PCP.
      • ESPs will cover the cost of the "home care" provided at the assisted living programs with whom they have contracts. The member would be responsible for the "rent" portion of the cost. PACE Plus- ALFs only have certain beds that are designated PACE beds for which they are willing to take PACE as full payment. Typically waiting lists for those beds (common to wait 2 years). Often difficult to get into a PACE bed from outside- more typically people go in as PACE Plus to wait for bed. Individual pays privately for the difference between the PACE benefits and the full cost of room and spend down assets to get through waiting period.
      • Eligibility – 55 or older. Higher income limit than SSI. Must be nursing home eligible.
      • Limitations – as noted above, MGH does not participate. Not all ALFs participate. Must live in a geographic area covered by an ESP.
      • Learn more about ESPs

    • Senior Care Options (SCO)- program for those with MassHealth alone or MassHealth and Medicare- attempts to combine benefits of both programs and limit paperwork, prior approvals, etc- more flexibility. Offer expanded services such as full dental, no pharmacy co-pays, broader access to services, team approach including case management. One does not have to be nursing home eligible to qualify. Similar to ESP programs (see above), SCOs may pay for a portion of care in an associated assisted living program for their members. Some limited MGH participation- check individual MDs.
      • Eligibility – 65 or older. Regular MassHealth income limits. Not required to be nursing home eligible.
      • Learn more about SCOs.

    • Veterans' Aid & Attendance Benefit - available to Veterans and surviving spouses. Provides a “pension” paid in addition to monthly pension. The amount depends on whether the applicant is the veteran, a veteran with a dependent, or a surviving spouse and income. The additional pensions goes towards care in the home, nursing home or assisted living facility. This is a little known/underutilized resource. Many do not know they are eligible.
      • Eligibility- The Veteran must have served at least 90 days of active duty, one of those being recognized as during a period of war. The veteran does not have to have service-related disabilities to qualify. Veterans or surviving spouses are eligible if they require the aid of another person to perform ADLs. Asset limit is $123,600 in 2018. Income must be less than the Maximum Annual Pension Rate (MAPR)- Aid and Attendance with no dependent is $22,577 annually in 2019 ($1,881 monthly). Income does not include welfare benefits or Supplemental Security Income. Unreimbursed medical expenses can be deducted from income- such as for assisted living, recurring scripts, insurance premiums, home care, etc. (Must be recurring costs.)
      • Limitations-  Commonly takes 1 year to 18 months to process.
      • To apply - contact the local Veterans Services Officer.
      • For more information see www.veteranaid.org or the VA.
      • Proposal to tighten eligibility criteria- MGH Community News, March 2015. Proposal would set specific asset limit, define asset transfer penalties and limit hourly rate of home health aides, among other changes.

         

    • Public Assisted Living - some facilities have public funding that allows them to offer reduced rates to those with a low or moderate income. Ask at the facilities you are considering. Also see Program Highlights below.

    • Bridge Loans - to help seniors’ families with the cost of assisted living, home care or skilled nursing on a short term basis, while awaiting the sale of a home or the receipt of Veteran’s benefits. Learn more: Assisted Living and Home Care Bridge Loans - MGH Community News, August 2015.

 

Assisted Living Residents' Rights

 

ALF in the News

 

 Assisted Living Program Highlights:

Geriatric Care Managers
  • Aging Life Care Association (Formerly National Association of Professional Geriatric Care Managers).
  • A Place for Mom - Free Senior Living Advisors - APFM can assist patients and families seeking placement for Assisted Living, Independent Living, Memory Care and private-pay (non-skilled) home care. They help families find senior living communities that meet their needs and offer advice and support. Services might include education about types of care and help matching to the patient’s needs, helping to schedule appointments and tours and offering emotional support through the process. Note of caution: they are able to offer services free to families as they are paid by their partner communities if a patient moves in. If engaging this service, please keep in mind that it is in their interest to recommend participating providers, and that their listings may not include all local facilities.
  • 2 Sisters Senior Living Advisors- offers free help to families to find elder supportive living options for their loved-ones. Note of caution: they are able to offer free services to elders and their families because they are compensated by providers when clients move in or choose their services. If engaging this service, keep in mind that it is in their financial interest to recommend participating providers. MGH Community News, April 2018

 

Congregate Housing (Massachusetts)

Congregate housing is a group living situation for seniors and adults with disabilities. Services are available to aid residents in managing Activities of Daily Living in a supportive, but not custodial environment. It does not offer 24-hour care and supervision. Each resident has a private bedroom, but shares one or more of the following: kitchen facilities, dining facilities, and/or bathing facilities. There are many variations in size and design.

Eligibility

You may be eligible for state-funded congregate housing if you:

  • are age 60 or older, or disabled
  • can live independently with support services
  • do not require 24-hour supervision or care
  • meet financial and other eligibility requirements for public or subsidized housing
    • have income below 80% Area Median Income
    • can show that you are likely to be a good tenant (they will check references, criminal background and credit history)
  • want to live in a shared living arrangement with other adults
  • do not have disruptive behaviors that would interfere with the rights of other residents

Services

Each congregate housing arrangement is different, and support services vary from one to another.

Residents of congregate housing can get (some included in rent, and others may cost extra):

  • a private bedroom or, in some facilities, an apartment
  • shared living space, such as a dining room, kitchen, and/or living room
  • a private or shared bathroom
  • social support of other residents
  • one or more group activities such as a meal or outing each day
  • support services, which may include meals, transportation, housekeeping, laundry, grocery shopping, emergency response system, and social and recreational activities

A Service Coordinator is available on site on a schedule that varies between sites. The service coordinator can help with the following, among other tasks:

  • Conduct assist in the application and screening process, and assist with moving in and out of the facility.
  • Supports the residents in a group living situation, including negotiating concerns among the residents.
  • Develop individual service plans based on each resident's need for ASAP clients, and collaborate with other residents' service coordinator's to ensure service plans fit with the needs and requirements of congregate living (i.e., cleaning of shared spaces, preparation of shared meals, contributions to common expenses).

Cost/Payment

Public or subsidized congregate housing facilities in Massachusetts are funded by the state government. You will usually pay 30% of your net income for rent if you are eligible.

Medicare does not cover the cost of congregate housing.

MassHealth will cover the costs of home health services for eligible residents if needed.

To Apply

You should apply for public or subsidized congregate housing at the housing agency or elder services agency in charge of the housing:

For more information, call or visit your local Aging Services Access Point (ASAP). To find the ASAP that serves your area:

Program Highlights

Rest Homes

Rest homes are licensed by the Massachusetts Department of Public Health to provide 24-hour supervision and supportive services for individuals who do NOT routinely need nursing or medical care. Rest homes provide housing, meals, activities and administration of medications for individuals who need a supportive living arrangement.

Paying for Rest Homes:

For a rest home stay, individuals may pay privately.

There are three other sources of potential assistance:

  1. Supplemental Security Income (SSI) - If one has a low income and otherwise qualifies for SSI, SSI recognizes Rest Home as a qualified living situation and would pay for care. Most of the SSI grant must be paid to the rest home. Learn more about SSI eligibility.

  2. In very limited instances, if one has very low income and assets and otherwise qualifies, EAEDC (Emergency Aid for Elders, Disabled and Children) may pay the rest home. The resident keeps $72.80 for Personal Needs Allowance (PNA) and pays the balance of his/her income to rest home; EAEDC pays the rest up to the total rate. If no income, EAEDC pays rest home and pays the resident $72.80 PNA. More on EAEDC eligibility and benefits.

  3. Veterans: Certain eligible Veterans may have their stay in a rest home paid for through the Veterans Administration. To find out if an individual is eligible for assistance, locate your city/town’s Veterans Service Officer : www.mass.gov/veterans/utility/local-veterans-service-officers-3.html or at (617) 210-5480; or the VA at: 1-877-222-VETS (8387).

Find a Rest Home:

Massachusetts Rest Home Listings - Listing of all health care facilities licensed by MA Dept. of Public Health. Scroll down to Rest Home listings (around program number 415) or use Find "rest homes".

www.800AgeInfo.com - see Search! For Services and enter "Rest Home" in search field.
   - NOTE: Listings include some assisted living and other agency types. Most listings do not include websites; call or search the internet to find related websites.

Mass Hospital Association list (DRAFT) - includes details of services, accessibility and more. (3/23)

Recommended Reading:

Aging in Place Communities & Alternative Models

These non-profit groups, usually started by community members themselves, generally charge an annual membership fee and in return provide services that can range from transportation, shopping, errand running, home repair, computer assistance and occasional meal preparation. These tend to appear in relatively affluent and educated communities.

The Center for Aging in Place lists groups nationwide and includes links to descriptive articles and other related resources.

 

Adult Foster Care

For a current list of programs see the Mass. Council for Adult Foster Care provider list: www.massafc.org/provider-list

Program recipients receive daily care and supervision while living with a caregiver. The caregiver may be a non-guardian (non-legally responsible) relative. The AFC program also provides nurse and case managers in addition to providing the caregiver with a stipend.

Eligibility factors include:

  • MassHealth Coverage types: Standard or CommonHealth
  • Clinical- daily hands-on physical assistance or cueing and supervision throughout the entire activity for at least one ADL (bathing, dressing, toileting, transferring, mobility, eating.) (Subchapter 4: Adult Foster Care Regulation - Clinical eligibility see: 408.416)

Program Highlight

Adult Family Care, Somerville‐Cambridge Elder Service's Adult Foster Care program.

The program serves MassHealth eligible people who cannot live alone due to a medical diagnosis. Caregivers through Adult Family Care receive a tax-free stipend, ongoing training, and two weeks paid respite annually. 

Adult Family Care provides:

  • Clinical Support, which includes monthly home visits from a nurse and social worker
  • A personalized care plan that meets the participant’s needs.
  • Monthly caregiver training, based on the participant’s diagnosis, caregiver needs, and general well-being.
  • Case Management that provides easy coordination of services, such as Meals on Wheels and Adult Day Health.

Eligibility Requirements:

  • The person receiving care must be age 16 or older and eligible for MassHealth Standard, CommonHealth, Senior Care Options, OneCare or PACE. 
  • The person receiving care must require assistance with at least one of the following: bathing, dressing, toileting, ambulating, eating, or transferring between positions.
  • The caregiver must live with the participant and be able to meet their daily needs.
  • The caregiver cannot be a spouse, legal guardian, or parent of a participant who is a minor.

Adult Family Care serves much of the Greater Boston Area.

More information or to make a referral.