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Helpful tips for family caregivers

What is a Medicaid spend down?

There are two forms of government health insurance:

• Medicare. Basically, age-based insurance for older adults (age 65+), regardless of income and assets. (Assets include money and belongings, such as a house or car.)
• Medicaid. Income-based insurance funded with federal and state dollars. (The state where your relative lives may have a name different than “Medicaid.”) This insurance is for individuals who have very little means. The financial asset threshold is often set at $2000 or less.

Medicaid sometimes pays when Medicare doesn’t. The most common expense covered by Medicaid is long-term care in a nursing home. Speaking very generally, Medicare pays for the first 100 days after a hospitalization. If a person needs to stay longer—permanently move into the facility—they must cover the cost from their own savings. Once nearly all their resources have been exhausted, they can apply for Medicaid, which will pick up the tab.

How to become eligible for Medicaid. Essentially, one needs to eliminate assets. Paying for care will certainly do that! For many, it’s tempting to dole out early inheritances in an attempt to “spend down” assets. Perhaps by giving the house to their children. Or passing their savings accounts to grandchildren. Beware! The government will look back for asset transfers in the past thirty months to five years. (It varies by state.) Persons deemed to have spent down by gifting are disqualified from Medicaid for an extended period of time. There is no wiggle room on this.

Get legal advice before taking action! Spend-down restrictions vary by state and are astoundingly complex. If you think that Medicaid will be part of your loved one’s financial strategy, consult an elder law attorney immediately! It’s never too early. There are ways to protect assets, but they require planning and attention to detail. There are too many pitfalls to try this on your own.

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Bladder issues

If making it to the bathroom in time is a frequent concern for your relative, they may have an overactive bladder. More than 33 million Americans contend with this condition, in which misfiring nerves cause the bladder muscles to contract involuntarily. Your loved one may be too embarrassed to bring it up with the doctor, or even with you. But it should be checked out. It’s not a “normal” part of aging. Overactive bladder (OAB) is a real and treatable medical condition. And you certainly want to be sure it’s not something else.

The basic symptoms of OAB include an urgent need to urinate more than eight times in a day and/or more than once or twice a night.

Many people let incontinence worries run their lives. They stay close to home for fear of accidents. They withdraw from social activities, dreading they have an odor from leaks. They may become anxious or depressed. And multiple nighttime trips to the toilet can result in insomnia and fatigue, bringing on more depression.

Once a doctor has ruled out other issues, encourage your family member to use these recommended strategies to live more fully with OAB:

• Limit caffeine and alcohol, and quit smoking. All three irritate the bladder.
• Drink six to eight glasses of water a day. This seems counterintuitive, but concentrated urine is a bladder irritant.
• Eat a high-fiber diet to prevent constipation, which tends to put pressure on the bladder.
• Lose weight, also to reduce pressure.
• Do pelvic floor exercises (Kegels) to learn how to consciously stop the flow.
• Do bladder exercises to train the bladder to retain fluid for longer.
• Go to the bathroom every two hours to proactively keep the bladder empty.

Depending on the cause, suggested medical treatments may include medications, injections, gentle nerve stimulation, or surgery as a last resort.

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