Dear Attorney Tully:  I read your articles about families working together and planning and think, how wonderful. But I am alone. My deceased husband and I had no children and we were both from out of state. All of my siblings have passed and I am alone. My health is failing. I have no one to take care of me, no one to gift my money to and to be honest, it is a bit frightening. What can I do?

ANSWER:  Studies show that older Americans prefer to stay in their homes if they possibly can. It is not a surprise then that most care of older persons is provided at home, whether by family or by hired help.  

While most people consider in home care preferable to institutional care, there are public benefits and legal considerations, some of which may be quite unexpected.

The first thing you must do is make sure that your financial and legal plans are up to date and that they work together. In our questionable economy and with recent tax and elder law changes, if your plans are more than a few years old, they may be outdated. What you are talking about is called aging in place. One of the most common concerns that seniors’ have is whether they will be able to stay in their homes for as long as they want.  

There are many financial concerns to consider with aging in place. These concerns are heightened when a single individual (widow/widower) has no family support system, in the community.

Family members often shoulder much of the burden of caring for seniors at home. Being the primary caretaker for someone who requires assistance with activities of daily living, such as walking, eating and toileting can be a consuming and sometimes exhausting task. When you are paying privately for all of your home care your costs can add up quickly.

To maintain your independence, age in place, and make your dollars last, you need to know your options and plan proactively.

The most effective way to plan is to develop the plan before you need it. Unfortunately, most plans are not developed until a senior is facing a crisis created by the need for nursing care.

In the case of a senior with no family to provide care, the burden of researching, coordinating and delivering care falls on the primary caregiver.

With no planning for your care wishes may not be carried out. Fortunately, most elder law attorneys are skilled in helping individuals and families devise creative solutions to such problems.

At the same time, state and federal government officials are slowly recognizing that home care can be more cost effective than institutional care. This means that, depending on the state, financial or other assistance may be available for those who chose to remain in the home despite declining capabilities.

Public and private agencies offer a variety of home care services that may be available to you, such as:

• Home health care, either part time or 24 hour care;
• Personal care and homemaking services, such as shopping, cooking and cleaning;
• Services delivered to the home, such as meal programs, transportation and home repair;
• Adult day care centers that offer more intensive services than senior centers (there are more than 2000 such centers affiliated with churches or nonprofit community agencies); and 
• Respite services that provide care takers a periodic break (a home care professional or aide substitutes for a caretaker for a specified period of time.)

Medicare and Medicaid provide some coverage of the medical portion of home health care. Although the coverage is often inadequate, when combined with other resources available to the client and his/her family, it may be enough to keep a fragile older person at home for a longer period of time.