Attorney offers advice on home care services

The three presenters discussed ways that seniors can plan for the future to stay at home. From left: Kathleen Samways, Sandie Corr-Dolby, and Arthur Bergeron. — Photo by Janet Hefler

There’s no place like home, as the saying goes. Fortunately, for many seniors who want to remain in their own homes but require some assistance, there are services available to help them stay out of nursing homes, as attorney Arthur Bergeron described Monday last week at the Tisbury Senior Center.

More than 60 people attended the second installment in a two-part legal clinic that began last month on the topic, “Living where you want with the care you need.” Mr. Bergeron invited Kathleen Samways, Vineyard Nursing Association (VNA) clinical director, and Sandie Corr-Dolby, co-founder of Horizons Geriatric Care Management, to join him at last week’s session, “Staying home no matter what.”

Mr. Bergeron said that most government home care services programs for seniors are designed to try to help them stay in their own homes. To start, he said it is important for people to be aware of how the services are provided and the programs are structured.

Every region in the state has an Aging Services Access Point (ASAP), Mr. Bergeron explained. The ASAP that covers Martha’s Vineyard is Elder Services of Cape Cod and the Islands.

“They are the great gatekeepers of just about all the money you can find to help you as you get older,” he said. “And, it is your tax dollars at work. They want to talk to you.”

The Executive Office of Elder Affairs is the state entity that provides a lot of the funding for Elder Services. At the local level, geriatric care managers (GCM) come into play, which Mr. Bergeron asked Ms. Corr-Dolby to explain.

She and her business partner, Beth Toomey, started Horizons Geriatric Care Management last January and took on their first client in June. Ms. Corr-Dolby is a registered nurse and a certified case manager.

“A geriatric care manager is an advocate for elders,” Ms. Corr-Dolby said. “We have studied and learned about all the programs available to help elders in our community. An elder may hire us, or their family or kids may hire us, to go in and try to help them navigate through a very complex medical system of both formal and informal caregivers.”

Informal caregivers may include family members, volunteers, neighbors, and church members, working in conjunction with formal paid caregivers such the VNA and other agencies, Ms. Corr-Dolby said. GCMs assess clients and make recommendations for enhanced services that make it possible for them to remain living in their homes — for example, transportation if they no longer drive, shopping, and laundry.

What’s available?

Many seniors may be unaware about services they could be receiving, Mr. Bergeron said.

“By calling ASAP, by virtue of being age 65 or older, you are eligible to receive some basic home care, about three hours a week, as long as you don’t make too much money,” he said. “Or, if you can demonstrate you have significant need beyond that, you can get six hours a week through the Enhanced Community Options Program [ECOP]. Maybe you need help dressing, making a meal, or doing basic activities of daily living at home.”

There is no charge for an individual with a gross annual income of $11,509 or less, or for a couple with a gross annual income of $15,510 or less. Individuals not on Medicaid are requested to make a voluntary co-pay of $9 per month and couples $17 per month.

Individuals with a gross annual income of up to $26,168 or couples with a gross annual income of up to $37,000 are also eligible for the benefit, but they will be charged a co-pay on a sliding scale, from $17 a month up to $140 a month.

Even with the co-pay, it’s still a bargain, Mr. Bergeron pointed out. The typical charge for such services is usually more than $20 an hour, so at six hours a week and 24 hours a month, the cost of the services would add up to about $500 a month.

“So you’re talking about a significant benefit for folks that just need a little help,” Mr. Bergeron said. “And most people will qualify for it because of those income levels. The access point for the services is the ASAP. Start there.”

Medicare options

Mr. Bergeron said that many people also don’t realize that Medicare is also a source of home services for eligible seniors, and is not tied to prior hospitalization.

On Martha’s Vineyard, the VNA is the certified Medicare care delivery organization, Ms. Samways explained. Home services may include skilled nursing care, physical therapy, occupational therapy, and ancillary home care such as home health aides, she said.

“We use the 60-day care plans to develop a plan of care with you and your doctor, so that you have a period of time to recuperate or recover from something that requires you to be homebound, and if you need some kind of skilled care in order to recuperate from being ill,” Ms. Samways said. “You can get a referral from your doctor’s office, or you or a family member can call in yourself and ask for assistance.”

The VNA would follow up with the doctor and patient, develop a care plan, and assess the person’s needs to determine whether he or she requires skilled nursing and meets the homebound qualification. In answer to Mr. Bergeron’s question about how many 60-day plans a patient could receive in a row, she said there is no limit as long as the VNA demonstrates the patient has a need for skilled care and improvement goals to meet.

Mr. Bergeron said Medicare’s 60-day care plans may be fundamentally changing as the result of a settlement agreement approved last January in the U.S. District Court of Vermont. In the case of Jimmo vs. Sebelius, the plaintiffs alleged that Medicare contractors were inappropriately applying an “Improvement Standard” in denying claims. Medicare will be revising its policies by January 23, 2014, to clarify that patients are entitled to skilled nursing services as long as necessary to prevent or slow deterioration or to preserve current capabilities.

Ms. Corr-Dolby said the case is especially significant for people with degenerative diseases such as Alzheimer’s and other types of dementia, Parkinson’s, and multiple sclerosis who will now be eligible to continue in home health care, especially in the areas of physical and occupational therapy.

Ms. Samways said the guidelines from Medicare will be out in January. “I think long-term care is going to look very different.”

The presentation ended with a brief question and answer session.

Mr. Bergeron, an attorney in the Mirick O’Connell law firm in Worcester, frequently provides educational programs on elder law topics to Councils on Aging. He began offering free legal clinics on Martha’s Vineyard in 2009.

Mr. Bergeron has practiced law in Massachusetts for more than 30 years. Elder law, estate planning, probate and trust administration, and land use matters are his focus. Many of his presentations are now available for viewing online at

To contact Elder Services of Cape Cod and Islands, call the main office in South Dennis at 1-800-244-4630 or the Oak Bluffs office at 508-693-4393.