Surprising Trends in Senior Living

The traditional senior housing market is undergoing a profound change. In 2018 senior housing occupancy fell to an eight-year low, even as the senior population continues to increase, as competition for the younger baby boomer market is ramping up and forcing a change to more traditional independent and assisted living options. Active adult concepts like Margaritaville are addressing this market segment that is turned off by the idea of “senior living.” Atria Senior Living is in a joint venture with Related Companies to build $3 billion in senior luxury housing in major metro areas while overall multifamily development with an intergenerational mix of renters is also fragmenting the traditional senior housing market. Occupancy challenges in traditional independent living and assisted living communities are also finding the retention of a reliable workforce to be a continuing challenge. The truth is that the advent of smart home technology and on-demand services ordered via a smartphone, as well as home care aides,  are enabling apartment and single dwelling living for more extended periods than ever before. Younger seniors tend to want to age in place for as long as possible.

In the skilled nursing arena, Medicare fee-for-service payment reform brings forward three major provisions: the change to the case-mix classification system, the skilled nursing facility Value Based-Purchase Program, and the skilled nursing facility Quality Reporting Program. The case-mix model focuses on the patient’s condition and resulting care needs rather than the number of care services provided to determine Medicare payment. The Value Based-Purchase Program shifts the Medicare payments from volume to value driven. Finally, the skilled nursing facility Quality Reporting Program is designed, through innovation, to provide meaningful, quality measure reporting, a reduction of paperwork, and a lowering of administrative costs.

These and other changes in Medicare are helping to create an influx of capital into the senior care market incentivizing innovative partnerships and cross-continuum service development. Investors and providers will be partnering with Medicare Advantage payors, retail giants, home health, pharmacies, technology, and other provider groups to reinvent and manage the quality and cost of senior care housing, products, and services. This influx of investment capital combined with technology is destined to create fresh ways to approach senior living needs and the services that provide for them. Web-based platforms and data analytics software continue to address the battle for the retention of the health care workforce while Telehealth solutions are enabling elders in rural markets to reach providers and connect with specialists. Voice recognition software is increasingly being integrated into resident units whether they are private homes or pay for service facilities. Partnering opportunities and joint ventures will continue to create new service models that will, in particular, meet the needs of home and community-based services.

When aging in place is no longer a viable strategy a senior is faced with where to go next. Marketing senior housing to the younger baby boomers is changing, and it is data-driven. In particular, the adult Gen X children of these seniors are helping their parents to make informed decisions, and they typically get their information from online sources. Social media has become a tech tool replacing older marketing models of senior housing communities. Operators can tell their stories, address negative reviews, promote positive news items, and create conversations. Gen X adult children will be looking to social media platforms to get real and varied opinion to validate their parents’ choices.

As Medicare Advantage increases its integration in the overall health care system, data collection and its conclusions are more critical than ever. Potential residents will also be addressing concerns about health care data. More data is being gathered than ever before by Centers for Medicaid and Medicare Services (CMS) on hospital readmission rates, the prevalence of falls, and other related health information and consumers will demand to know what these statistics are before entering into a contract with a senior living community.

Seniors are being presented with more living options than ever before and the competition for their dollars will keep providers in the senior living industry highly focused and fiercely competitive. Questions facing seniors include: How and where do you want to live as you age? Are you well informed about the changing options available to you? Do you have a plan in place that is legally documented for the stages of your senior life? We can help. Give us a call and let’s start planning together.

How Veterans Benefits Can Help Pay for Senior Care

If you are 65 or older and served in the military during wartime or are the spouse of a wartime veteran, you might qualify for veterans’ benefits, like Aid & Attendance, a pension and housebound care. More than 30 percent of seniors might be eligible for these valuable programs from the Veterans Administration (VA), yet very few apply for these benefits. You earned the right to this assistance, by serving our country. It can improve your quality of life, if you learn how veterans benefits can help pay for senior care.

Aid & Attendance

If you need assistance from another person and you qualify for a VA pension, you might be able to get an extra monthly payment above the amount of your VA pension. You do not have to be already getting a VA pension to qualify for Aid & Attendance.

You will have to apply for both programs to get Aid & Attendance. Because the factors to qualify for the two programs, a VA pension and Aid & Attendance, are different, it is possible to get Aid & Attendance and not be eligible for a VA pension.

Other terms for Aid & Assistance are:

  • Veterans eldercare benefit
  • VA assisted living benefit
  • Improved pension

The maximum that a person who qualifies for both a VA pension and Aid & Attendance can receive is $26,766 a year (as of November 2019) for a qualifying veteran with a spouse or one dependent. If two qualifying veterans are married to each other, they can collect up to $35,813 a year. These numbers can change every year.

VA Pension

You should not delay in applying for a VA pension. It takes about nine months, on the average, to go through the application process and get approval of your VA pension request. Once approved, you can get retroactive benefits to the time you applied. Providing all of the required documents and completing the paperwork at the outset, can get your benefits started much more quickly.

In general, the requirements for a VA pension include having served in the U.S. military for at least 90 days of active duty. At least one of those days must have been during an active time of war. You must also meet at least one of these factors:

  • You are a patient in a nursing home.
  • You are totally and permanently disabled.
  • You receive Social Security Disability Insurance (SSDI) benefits.
  • You receive Supplemental Security Income (SSI).
  • You are 65 or older with little or no income.

The dates of wartime include World War II (December 7, 1941 through December 31, 1946); the Korean Conflict (June 27, 1950 through January 31, 1955); the Vietnam War (August 5, 1964 through May 7, 1975 – or beginning as early as February 28, 1961 for personnel who served in Vietnam itself); and the Gulf War (August 2, 1990 to a future date).

Housebound Benefits

If you qualify for the basic VA pension, you might also be eligible for housebound benefits. You must be confined to your immediate premises, as the result of a permanent disability. For purposes of this program, “housebound” means you only leave the house to go to doctor appointments and necessary medical treatments or you need someone’s help whenever you leave home. If you qualify for both housebound benefits and Aid & Assistance, you cannot collect both, but you will receive the higher benefit.

Contact a VA accredited attorney for help in determining or planning for eligibility, as well as applying for Aid & Attendance.  Fisher Law LLC attorneys are VA accredited.



A Place for Mom. “Guide to VA Benefits & Long-Term Care.” (accessed November 21, 2019)


Are You Prepared to Age in Place?

If aging in place is your goal, then long-term planning needs to be considered, including how the house will function as you age, accommodations for the people who will care for you and how to pay for care, says the Record Online in the article “Start planning now so you can ‘age in place.’”

Many homes will need to be remodeled for aging in place, and those changes may be big or small. Typical changes include installing ramps and adding a bathroom and bedroom on the first floor. Smaller changes include installing properly anchored grab bars in the shower, improving lighting and changing floor covering to avoid problems with walkers, wheelchairs or unsteady seniors.

Choosing a caregiver and paying for care are intertwined issues. M any adult children become caregivers for aging parents, and for the most part they are unpaid. Family caregivers suffer enormous losses, including lost work, career advancement, income and savings. Stress and neglect of their own health and family is a common byproduct.

You’ll want to speak with an elder care attorney about how or if the parent may compensate the child for their caregiving. If the payment is deemed to be a gift, it will cause a penalty period, wherein Medicaid won’t pay for care. A caregiver agreement drafted by an elder law attorney will allow the parents to pay without a penalty period.   However, the child will need to report this income on his or her tax return.

Self-paying for home care is another option, but it is expensive. The average cost of home health care in some areas is $25 per hour, or $600 per day.   Self-pay, depending upon the number of hours needed each day, can be as, or more, expensive that paying privately for skilled care in a nursing home.    To offset the high cost of private pay care, there are several options that include long term care insurance and qualifying for Medicaid, which is called MassHealth in Massachusetts.

The best way to plan ahead for aging in place, that is paying for care while staying at home, is with the purchase of a long-term care insurance policy. If you qualify for a policy and can afford to pay for it, it is good way to protect assets and income from going towards long term care costs. You can also relieve the family caregiver from duties or pay them for caregiving out of the insurance proceeds.

Without long-term care insurance, the next option is to apply for community Medicaid to pay for care in the home, if available in your state.  In Massachusetts, Massachusetts Medicaid—called MassHealth—operates the Frail Elderly Waiver specifically to help residents who require nursing home level care to receive health care and ongoing support services in their homes or community living residences instead of in a nursing home.  The objective of this program is two-fold. Lawmakers’ intention was to provide residents with an option regarding their long-term care. Additionally, by preventing the placement of frail individuals in nursing homes, the state saves significant financial resources as the burden of caring for these individuals is shifted onto family caregivers. Despite this, many families and care recipients still prefer this model as it allows them to age in their homes or the homes of other family members.  The Frail Elderly Waiver is operated by the Executive Office of Elder Affairs (EOEA). There is a version of this program called the Community Choices Program that provides more hours of services to those at immediate risk for nursing home placement.

Eligibility for this waiver depends on the age, location, functional ability, and financial status of the applicants. Candidates must be a minimum of 60 years of age. However, those between the ages of 60 and 64 must be physically disabled. All applicants must require the level of care provided in nursing homes, yet they should be willing to receive the care at home. The cost to provide that care cannot exceed what it would cost in a nursing home.

To be eligible for the HCBS Waiver, persons must be financially qualified for MassHealth Medicaid. The 2019 income limit is $2,313 per month for an individual. The income of married couples with both spouses as applicants is considered separately. This means each spouse is allowed up to $2,313 / month in income.

Fortunately, Massachusetts also maintains an alternative method to qualify if one is over the income limit. Individuals who have very high medical expenses can qualify through the Medically Needy pathway for MassHealth. As of 2019, individuals should not have more than approximately $552 in monthly income after medical expense deductions, and couples are limited to approximately $747 after subtracting medical expenses.

MassHealth also considers one’s countable assets, which includes cash, bank accounts, certificates of deposit, and life insurance policies with a face value over $1,500. The limits for an individual and a married couple (both spouses applying for services) respectively are $2,000 and $4,000. However, as with the income limits, there is flexibility. When only one spouse of a married couple is applying, the asset limit for the other spouse is up to $126,420 (as of 2019). Their home, if owner-occupied, is considered exempt up to a value of $878,000 in 2019. There are also other exempt assets, such as a vehicle, funeral trusts, and personal valuables.

As with other state Medicaid programs, the applicant’s five-year financial history is considered to prevent the applicant from giving away his / her money to qualify. (This is called the Medicaid Look-Back Period.) A professional,who is familiar with state Medicaid rules, such as an elder law or elder care attorney, can determine the exact limits and the best structures for resources to ensure a qualification, while also preserving some of the couple’s net worth for the healthier spouse.

Planning in advance with a careful analysis of the different choices tailored to your specific goals will ensure that you fashion the optimal blueprint.

Reference: Record Online (Aug. 31, 2019) “Start planning now so you can ‘age in place’” and