Elder Care FAQ — Answers for New Jersey Families

Long-Term Care Medicaid and Managed Long-Term Services and Supports are two of the main Medicaid programs that cover long-term care in NJ. The programs have the same guidelines, including a 5-year look back in terms of all finances. In NJ, the recommendation is for individuals to begin this application once liquid assets, including bank accounts, stocks, bonds, life insurance, etc., are at $64,000 or below. For a married couple, the recommendation is to begin this application process once combined liquid assets are below $150,000.

In NJ, the income limits for Long-Term Care Medicaid and Managed Long-Term Services and Supports are higher than regular Medicaid. Because the cost is so high for long-term care, many individuals do not have the monthly income to pay for this. For example, if your monthly income is above approximately $2,900 per month, individuals can apply for the Managed Long-Term Services and Supports (MLTSS) program, and qualify by setting up a Qualified Income Trust, which is permitted.

This particular program provides the most assistance at home and can transition to Long-Term Care (LTC), if this becomes necessary. There is a financial test, including a 5-year look back in terms of finances, assets, etc. There is also a medical test, whereby the individual for whom the application is being made must require assistance with a minimum of 3 activities of daily living, such as bathing, dressing, cooking, medication management, etc. Once approved, there are multiple covered services that can assist with the individual’s care, such as adult day centers, home health aids up to 40 hours per week, case management services, supplies, transportation to and from medical appointments, equipment, and 30 days of respite care per year in a facility if needed.

The reason the process takes 2-3 months is due to multiple factors. The shorter the amount of time it takes to secure all of the requested documentation, the quicker the process will be. The local county Board of Social Services will assign a caseworker to review your application. They will go through all of the documentation, including each of the monthly bank statements for 5 years, i.e. 60 bank statements. They specifically look for larger transactions, monies that may have been gifted, etc. They also look for any property or asset transfers within the 5-year period as well. Many times, they will request additional documentation throughout the process. Additionally, some of the necessary documents are difficult to secure, such as birth certificates, marriage certificates, divorce paperwork, etc., which will simply add to the processing time.

Yes, but with significant limitations. New Jersey Medicaid can cover assisted living through the Assisted Living Program (ALP), but there are a limited number of Medicaid slots available in facilities. Most facilities require that new residents have the ability to pay privately for at least 18-24 months before accepting them. When a Medicaid slot becomes available, facilities typically reserve it for a current resident who has spent down their assets, rather than accepting a new admission directly on Medicaid.

The 5-year lookback period means that when you apply for Long-Term Care Medicaid or MLTSS in New Jersey, the state reviews all financial transactions from the previous 60 months. They examine every bank statement, asset transfer, and large transaction to ensure no improper gifting or transfers occurred. Any transfers made for less than fair market value during this period can result in a penalty period where Medicaid will not cover care costs. This is why early planning is crucial.

In most cases, yes. Your primary residence is typically exempt from Medicaid’s asset calculations while you or your spouse are living. However, after your passing, Medicaid Estate Recovery Program (MERP) may place a claim against your estate to recover costs paid for your care. There are some exceptions and protections available, particularly if a spouse or disabled child is living in the home. It’s best to consult with an elder care attorney to understand your specific situation and explore protective strategies.

For Long-Term Care Medicaid and MLTSS in New Jersey, the asset limit for an individual is generally $2,000, and $3,000 for a married couple (not including exempt assets like your home and one vehicle). For married couples where one spouse needs care, the community spouse (the one not needing care) is typically entitled to half of the joint assets, though this amount adjusts annually. Many times, individually owned assets or accounts are considered to be owned by that individual. It’s important to note that certain assets don’t count toward these limits, including your primary residence, one vehicle, personal belongings, and pre-paid funeral arrangements.

Nursing homes in New Jersey typically cost approximately $12,000 or more per month. The exact cost is specific to the facility itself, as each facility has different staffing, different vendors, etc., that impact this. They are there to make a profit. The cost can vary based on the level of care required, the facility’s location, amenities offered, and whether specialized services like memory care are needed.

Assisted Living Facilities in New Jersey typically cost about $6,000 per month or higher. This cost is dependent largely on the amount of assistance the individual requires, costs of medications, etc. Some will include a few services in the monthly cost, and have various levels of care, while others will carve out each service as an additional cost, added to the base monthly price. The more services an individual needs, the higher the monthly cost. Make sure you are aware of what services are included and what services are a la carte.

The main difference between the two involves the amount of care that is available. The long-term care setting provides 24-hour nursing coverage by an RN in the building. The staffing availability is higher than in assisted living facilities, so that they are able to provide 24-hour assistance with such things as toileting, transfers, medications, vital signs, wound care, IV antibiotics, feeding, etc. They have the capacity to care for individuals with more complex needs and who require more physical assistance. Assisted living facilities are generally more appropriate for individuals who require less supportive care. In assisted living facilities with secure, locked dementia or memory care units, there is 24-hour care. The care that is provided in the assisted living facilities does vary significantly based on the specific facility, their staffing, etc. Speak with each facility admissions/administrator to obtain this information prior to selecting a facility.

Medicare only covers nursing home care under very specific circumstances and for a limited time. Medicare will cover up to 100 days of skilled nursing facility care following a qualifying hospital stay of at least 3 days. Days 1-20 are fully covered, and days 21-100 require a daily copayment. However, Medicare does NOT cover long-term custodial care, which is what most people need. For long-term care beyond 100 days, families must either pay privately or qualify for Medicaid. This is one of the most common misconceptions about Medicare coverage.

This difficult decision typically comes when your parent needs more care than can safely be provided at home. Key signs include: requiring assistance with multiple activities of daily living (bathing, dressing, toileting, eating, mobility), experiencing frequent falls, wandering and getting lost, having complex medical needs requiring 24-hour monitoring, or when the primary caregiver is experiencing burnout or health issues. Safety should be the primary concern. If your parent is at risk of harm at home, even with home care services, it may be time to consider a nursing home or assisted living facility with appropriate staffing levels.

This can vary, though generally speaking, you will observe some forgetfulness, repeated questions, difficulty finding words, difficulties navigating in unfamiliar settings, difficulties with changes in routines, getting lost outside the home, etc. You may also see issues with banking/money management, where errors are made, particularly with reference to date and time. They may not know what to pay, if something was paid, etc., because they can’t identify what is current. Forgetting medications, meals, appointments, etc., is also common. They are sometimes confused if it is day or night. Many times they will be up more at night and sleep more during the day. As later afternoon and evening approach, they become more confused. These are not all of the signs, though some of the signs that are more frequently seen.

Wandering can be very dangerous for multiple reasons. Individuals may forget where they are and place themselves in risky situations, where others could easily take advantage of them, stealing monies, etc., or even physically harming them. Many times they wander out of the home, inappropriately dressed for the weather, which places them at risk as well. One of the ways that families are utilizing today’s technology is by using a location finder on devices such as smartphones, smart watches, etc. Some families will place some type of alarm on the doors of the residence to alert them when a door is opened. Dependent upon how severe the issue, placement in a secure, locked setting may be necessary.

When a loved one becomes paranoid, this generally comes out of fear, as the messages coming in to the brain are skewed. They believe that someone must have moved or taken something that the individual actually misplaced or lost themselves, as they know where something was placed. Reassurance and understanding can help. It is not uncommon to see this behavior. Understand that they do not realize that they may not be able to recall where they may have put something or left something. They may be having trouble managing their monies, therefore, think that someone is stealing from them. Dependent upon the severity of the paranoia, medications may be necessary, in an effort to take the edge off of the fear and anxiety that you see, so that the individual can be redirected and comforted. Medication management is best done by working with a geriatric psychiatrist.

Understanding the possible reasons for this can help. The individual may not understand what is happening as well as the reasons why they need care. They do not see themselves as getting older, but rather, they perceive themselves as younger than they are. They can become frustrated and angry when confronted, for example, that they missed meals, medications, etc. Many times, they truly believe that they ate, took medications, etc. Confronting them in an argumentative way will typically only escalate the agitation. Letting the individual know that you are there to support them and that you are concerned about them, in a calm manner, is typically more effective. Also effective is sometimes changing the subject to something that they enjoy talking about. Try to introduce help into the home slowly, in smaller, shorter increments. As your loved one becomes more accustomed to having someone come into their space, they will sometimes become less resistant to this idea over time.

Setting up a routine for the individual is one of the best ways to have them eat on a regular basis. Establishing this early on can be helpful. Sometimes, this is accomplished by setting reminders on cell phones, by phone calls to check in, or by having others around them to let them know it’s time to eat. Understand, many times they truly feel that they have had a meal, not realizing they haven’t. Many elderly people no longer make the home-cooked meals that they may have done previously, as they may have difficulty remembering how to make those meals, following a recipe, standing too long, or using their arthritic hands, etc. Many rely on eating fast food. There are multiple options now, which are healthier, including dietary supplements such as Boost or Ensure, microwave meals, meal delivery services, and prepackaged meals that require minimal preparation. Another factor is that their sense of taste is diminished. It appears that the sense of taste that remains the strongest is for things that are sweet. If something is sweet, it seems that they are more likely to eat it. Sharing meals with someone, rather than eating alone, generally helps to encourage better nutrition.

This is likely a combination of different things. There is a general fear of falling in the shower and injury resulting from that. If they require assistance with bathing, there is also concern around modesty. For many elderly people, they do not wish anyone to see them naked. That is a reflection of the time when they grew up. Some may feel that they are being sexually assaulted, when someone else is touching their private areas, to ensure they are thoroughly clean. There also seems to be a general fear of water, particularly when the water is coming down from an overhead shower.

This depends on the stage of dementia and the individual’s ability to perform activities of daily living safely. In early stages, someone with mild cognitive impairment, or early dementia, may be able to live alone with support systems in place, such as regular check-ins, medication management assistance, and meal services. However, as dementia progresses and they begin experiencing issues with remembering to eat, taking medications, or if they start wandering, living alone becomes unsafe. Key warning signs that living alone is no longer safe include: forgetting to turn off the stove, not recognizing when they need help, leaving the home and getting lost, or no longer managing basic hygiene. Safety should always be the primary consideration.

The progression of dementia varies significantly depending on the type of dementia and the individual. Alzheimer’s disease, the most common form, typically progresses over 8-10 years from diagnosis, though this can range from 3-20 years. The disease progresses through stages: early (mild), middle (moderate), and late (severe). Some forms of dementia, like vascular dementia, may progress in a step-wise pattern with periods of stability followed by sudden decline after strokes. Lewy Body dementia tends to progress more rapidly. Factors that can influence progression include: overall health, age at diagnosis, genetics, and whether other medical conditions are present. Regular monitoring by healthcare professionals can help families anticipate and plan for changing care needs.

The 7 stages of dementia, based on the Global Deterioration Scale, are: Stage 1 (No impairment) – normal function; Stage 2 (Very mild decline) – minor memory lapses; Stage 3 (Mild decline) – noticeable memory problems, difficulty with complex tasks; Stage 4 (Moderate decline) – clear cognitive decline, difficulty with finances, recent events, may deny problems; Stage 5 (Moderately severe decline) – major memory gaps, need help with daily activities, confusion about time/place; Stage 6 (Severe decline) – significant memory loss, personality changes, need extensive help with daily care, may not recognize family; Stage 7 (Very severe decline) – loss of ability to communicate, respond to environment, control movement, and require full-time care. Understanding these stages helps families anticipate care needs and make appropriate planning decisions.

Yes, you should be concerned. Many times, this is one of the first signs that you will see of dementia. Acknowledging that this might be the case, you can have an individual further evaluated to secure additional confirmation as to whether or not the individual has dementia, or there is any other potential cause. This is the time to act, and start both short-term and long-term planning. Begin looking at finances, medications, etc., to see if there are any indications that they are struggling in those areas. It provides you with additional time to make any necessary adjustments.

There are multiple strategies that can be used. These are dependent upon the actual living situation, such as if the individual resides with family, lives alone, medical conditions, etc. The easiest way to think about it is to essentially childproof the home. You want to ensure that potentially harmful objects and situations are not readily accessible. Using a stove can be particularly challenging, for example, therefore, sometimes knobs are removed. Sometimes individuals will install nanny cams, so that family can see where the individual may be, what they may be doing, etc. Interventions can then be developed to alleviate dangers that occur.

Trying to lessen the chance of falls can be done by minimizing tripping hazards in the home, ensuring pathways are clear of objects and clutter that may impede utilizing a cane or walker, and ensuring that the appropriate assistive device for mobility is available. Sometimes, things such as chair pad alarms can be helpful as well, to provide some advance notice that an individual may be getting up. You should speak with your loved one’s primary care physician, as there may be a medical cause for falls, such as a stroke, orthostatic hypotension, etc. The primary care physician can then examine your loved one and order any necessary testing in an effort to ascertain the possible cause of the falls. Referrals can then be made to any appropriate specialists, if needed. The primary care physician can also order therapies, which can be done in an outpatient setting or in the home, through Visiting Nurse Association services. A physical therapist can then make recommendations as to any medical equipment that might be beneficial as well as adjustments that can be made in the home to decrease the risk of falls.

Many elderly people are very reluctant to drink enough. The more that they drink, the more they will have to go to the bathroom. For some, just getting up to go to the bathroom is difficult, so they try to minimize how many times they need to go. Many require ongoing encouragement to drink enough, in the form of reminders. Having them eat something that is salty, diet permitting, can make them thirstier, thereby making them drink more. Setting up routines can help with hydration. Having prepared drinks readily available is also helpful. Sharing drinks or meals with someone, rather than drinking alone, generally helps to encourage better hydration.

In an effort to keep individuals mentally and socially engaged, many families will look into places such as adult day centers, nutrition sites, and senior centers, to ensure their loved one is around others. Considerations should be given to their level of function, when exploring options. Also, it can be helpful to have their hearing checked, as this has significant impact on interactions and maintaining language ability. There are multiple ways to promote stimulation. There are puzzle books, in large print, which can help. There are certain TV shows, which can also help. Going out and participating in various activities, hobbies, is helpful. Joining a club, attending religious services, and volunteering can also be beneficial. Choose activities based on their past interests and current abilities.

There are multiple options to consider. The most significant factor when considering the options is finances. The more finances that are available, the more options you have. For those with finances, private-hire assistance is a very common option. The assistance can vary from a few hours to live-in or 24-hour care, if a short respite is needed. Another option is a care facility, such as assisted living or skilled nursing facilities. At times, these are used for respite as well, when caregivers are going away or become ill. Adult day centers can offer breaks, and can be paid for privately, through sliding scale fees or through Medicaid. For those without private finances, some families will rotate care among family members to provide breaks. There is the option to complete an application for Medicaid programs, particularly programs like MLTSS. The MLTSS program can provide the most assistance at home, though it can be very challenging to secure reliable assistance through the companies who contract with the managed Medicaid provider.

Yes. You can apply for FMLA to care for a family member, under certain circumstances. This can be taken as a continuous leave or an intermittent leave. There are specific criteria that must be met to allow you to utilize FMLA, and the family member’s physician must complete the necessary documentation in support of this. Dependent upon the relationship with your loved one, there is the possibility that you can apply for FMLA. To apply for FMLA protection, you must have worked for your current employer for at least 1 year.

Contact your local county Office On Aging. They will ask a series of questions to determine if your loved one qualifies for this service. There is limited availability to provide specialized diets though. The meals are delivered once daily, generally around Noon, and the delivery person typically must see the individual to give them the meal. Your county Office On Aging has a multitude of resources available. These include Meals On Wheels, linkage with county transportation, county homemaker programs, etc. Programs may not start immediately, so planning ahead is best.

Contact your local County transportation agency. They will also ask a series of questions to determine eligibility. You can then discuss what needs your loved one might have, such as assistance with transportation to the grocery store, doctor appointments, etc. For certain needs, such as the need for transportation via a wheelchair ambulette, the trips must be scheduled in advance because there is limited availability.

Yes, there are programs in New Jersey that allow family members to get paid for providing care. If your loved one is eligible for Medicaid, there is a program whereby a family member can be paid to provide care, or families can receive a monthly allowance to support care, whereby they can secure their own assistance. The Personal Preference Program (PPP) through New Jersey Medicaid allows qualified individuals to hire and pay their own caregivers, including family members. Additionally, some long-term care insurance policies may cover family caregiver costs. It’s important to note that payment for family caregivers typically requires that the care recipient qualify for Medicaid or have other funding sources in place.

As a caregiver, it is very challenging to ensure that you are taking care of yourself as well as caring for your loved one. Caregiver burnout is real and can affect your own health. Key strategies include: taking regular breaks through respite care, accepting help from family and friends, joining a caregiver support group, maintaining your own doctor appointments and self-care routines, and not feeling guilty about needing time for yourself. Remember, you need to take care of yourself so that you can continue to care for your loved one. Don’t feel like you are being selfish. If you have an appointment, consider having a family member relieve you for that time, or, if that isn’t possible, consider paying someone to come in to stay with your loved one while you are away. Warning signs of burnout include: constant exhaustion, frequent illness, increased irritability, withdrawal from friends, and feeling hopeless. If you’re experiencing these symptoms, it’s time to seek additional support.

Respite care is temporary care provided to give the primary caregiver a break. This can range from a few hours to several weeks. In New Jersey, respite care can be obtained through several sources: MLTSS Medicaid waiver program provides up to 30 days of respite care per year in a facility, if needed; adult day centers offer daily respite; private home care agencies can provide in-home respite care (paid privately or through insurance); some assisted living and nursing facilities offer short-term respite stays. To access respite care through Medicaid programs, you must first be enrolled in MLTSS. For private pay options, contact local home care agencies or facilities directly to inquire about availability and costs.

Any facility has the right to deny admission to that particular facility for a multitude of reasons. Some common reasons can include, but are not limited to: not in-network with insurance, behavioral concerns, psychiatric concerns, medical complexity, and no beds available. Each facility is aware of their capabilities and will base admissions decisions on those capabilities. Any facility to which you are applying for admission for your loved one will review their pertinent medical, behavioral, financial, and social information to determine if that particular facility feels that they are able to meet your loved one’s needs. Any individual facility is under no obligation to accept any particular person. The facility is also under no obligation to provide you with any specific reason(s) for a denial.

Maybe. To execute a Power of Attorney document, a notary or attorney must certify that the individual, at the time the document is executed, understands what they are signing and is able to indicate whom they wish to act in that capacity. If an individual is unable to delineate the necessary level of understanding, a Power of Attorney document cannot be executed. Dependent upon how advanced the dementia is, execution of those documents may not be possible. A Last Will and Testament can also be brought into question, if an individual has a diagnosis of dementia when the document was executed. Enlisting the assistance of an attorney can be very helpful. It is best to have the documents completed when an individual is fully aware of what they are signing and can clearly indicate wishes, etc.

When a facility agrees to accept an individual as Medicaid pending, they are in agreement to care for the individual with no payment at the time. Typically, the facility will request that a family member complete their facility’s financial application, so that they can assess, for themselves, if they feel that the individual will be approved for Medicaid. The facility will also want to know how far along in the Medicaid application process that the individual is. Facilities prefer that this be in process, with potentially an assigned Medicaid worker, before considering the individual for admission with Medicaid pending. Once approved, Medicaid does allow for back billing up to three months, and therefore want to ensure that there is a good potential that this can occur. If a person were to pass away in the midst of the process, the facility will not be paid, as the application process will stop. It is a risk that only some facilities are willing to take, therefore, facility options are generally much more limited. When a facility is accepting an individual with Medicaid pending, the facility is essentially accepting that individual without any source of payment. The hope is that, when an individual would be approved, the facility would be able to bill Medicaid for the time that the individual has been in their care. If there is a delay in the approval process (such as a penalty period, or there is a delay in obtaining and submitting all of the necessary documentation), or if there is an ultimate denial of Medicaid for some reason, the facility then has no revenue source to care for that individual and would look to discharge that person.

Power of Attorney (POA) is a legal document where a person (the principal) voluntarily grants someone else (the agent or attorney-in-fact) the authority to make decisions on their behalf. This can only be established while the principal has mental capacity. Guardianship, on the other hand, is a legal relationship created by a court when someone is deemed incapacitated and unable to make their own decisions. A court appoints a guardian to make decisions for the incapacitated person. Key differences: POA is voluntary and established before incapacity; guardianship is involuntary and requires court involvement. POA is much less expensive and time-consuming than guardianship. This is why it’s critical to establish POA documents while your loved one still has capacity, as obtaining guardianship later requires a court process, medical evaluations, and can be costly.

While it’s not legally required to have an attorney to apply for Medicaid in New Jersey, it is highly recommended in most complex cases. The Medicaid application process, particularly for the Long-Term Care and MLTSS programs, is complex and involves significant financial documentation spanning 5 years. An elder law attorney can help you: navigate the complex rules and regulations, avoid costly mistakes that could result in denial or penalty periods, understand asset protection strategies that are legally permissible, properly structure finances to meet eligibility requirements, and appeal if your application is denied. For straightforward applications with limited assets and no complications, some families successfully apply on their own with help from case managers or social workers. However, if you have significant assets, complex financial situations, or want to protect assets for a spouse, an elder law attorney’s expertise can be invaluable and often save you far more than their fees.