Understanding Senior Service Providers and Resources

Rose was 81, a retired accountant in West Palm Beach who still kept every receipt in a labeled folder and still beat her daughter at gin rummy most Sunday afternoons. On the Thursday before Thanksgiving, she slipped on the edge of the bath mat. The ambulance came, the hospital admitted her, and by Friday morning Karen was sitting in a waiting room with a discharge planner’s clipboard and a list of words she had never needed before: skilled nursing, home health, assisted living, rehabilitation, custodial care.

In the next seventy-two hours, Karen heard five different answers from five different well-meaning people. The hospital discharge worker said her mother needed rehab first, then a decision. The doctor said home health with a private duty nurse, if they could find one. A close friend swore by her mother’s placement agent, who had found the right community in a single weekend. The neighbor, a retired nurse, said do not move anybody anywhere until they had talked to an elder law attorney about Medicaid. And Karen’s brother, who lived in Tampa, kept repeating the same thing: just sell the house, and everything else will work out.

Everyone meant well. Nobody agreed. One nurse told Karen to ask for the care coordinator, and Karen assumed that was the same person as the placement agent, and the discharge worker, and half the people on the hallway, until she finally stopped someone and asked, “Who exactly is on first?” She laughed at her own joke for about two seconds, and then she cried. If you have ever felt that lost in the middle of someone else’s alphabet soup, this chapter is for you. The good news is that the cast is smaller than it looks, the roles are learnable, and once you know who does what, the right first call stops being a mystery.

What this chapter covers

This chapter is a big-picture tour of the senior care industry and its stakeholders: the professionals who help you figure out what you need, the ones who help you pay for it, the ones who protect your legal and financial position, and the ones who make daily care actually work. For each player you will find a plain-language description of what they do and a short “when to call” line, so the next time someone throws a title at you, you will know whether that person is on your team, and when to bring them in.

Navigating Care and Service Needs

These are the professionals families meet first: the ones who help you answer the question “what does Mom actually need?” before anyone starts moving furniture or signing papers.

• Geriatric Care Managers

  These are (generally) licensed nurses or social workers who specialize in geriatrics. You can think of them as private advocates and guides who can help you and your family to identify and meet your needs.

  When to call: when you need an expert who looks at the whole picture, gets to know your parent, and tells you honestly what the needs are.

• Placement Agents

  These are professionals who help families determine which local senior living communities would be best suited for their loved ones. They understand the landscape of the local market and have relationships with care communities. By spending time with you and your family to understand the senior’s needs, they can evaluate the best match between your loved one and the right community. Their services are provided to families free of charge.

  When to call: when a senior living community might be the answer, and you want a free expert to narrow a long list down to the right few.

• Care Coordinators

  Think of them as the liaison for seniors and families in a care network focused on addressing the needs of the senior. They supervise interdisciplinary care by bringing together the different specialists whose help the patient may need. The coordinator is also responsible for monitoring and evaluating the care delivered. They can answer questions and perform assessments.

  When to call: once care is active, when someone needs to pull the specialists together, track how the care is going, and answer the family’s day-to-day questions.

Benefits

If your loved one served in the military, or if you think Medicaid may have to be part of the plan, these two professionals can protect benefits that most families never knew they had.

• VA Accredited Representatives

  Individuals who have undergone a formal application and training process and are recognized by the U.S. Department of Veterans Affairs (VA) as being capable of assisting claimants. (See Chapter 10: Veterans Benefits.)

  When to call: before you file any VA claim, so an accredited expert helps you put the strongest claim together the first time.

• Certified Medicaid Planners (CMPs)

  These are professionals in the Medicaid planning field who have been certified by the Certified Medicaid Planning Governing Board. They can help you navigate through the current rules of Medicaid and find the most cost-effective plan for your situation. (See Chapter 8: Understanding Medicare/Medicaid.)

  When to call: when you believe Medicaid may help pay, and you want to plan within the rules instead of reacting after the fact.

Legal

• Elder Law Attorneys

  They handle a wide range of legal issues affecting a senior or disabled person, including issues related to health care, long-term care planning, guardianship, retirement, Social Security, Medicare/Medicaid, and other important matters. (See Chapter 4: Elder Law Attorneys.)

  When to call: when legal documents, guardianship questions, or long-term care planning need an attorney’s strategy behind them, not just a signature.

Real Estate

For many Florida families, the house is the largest asset on the table, and the way it is sold can shape the whole care plan. Here are the two very different ways to sell it.

• Realtors

  These are real estate agents who can help you to list your house for sale in a traditional way. They typically work on commission and are paid a percentage of the property’s sale price. (See Chapter 10: Selling the Family Home.)

  When to call: when you have the time to prepare the home and want it marketed to the widest possible audience for the best net price.

• “As-Is” Certified Home Buyers

  These are not realtors, but individuals who specialize in purchasing homes for cash in “as-is” condition with all the “stuff.” They do not charge a commission for their services. (See Chapter 10: Selling the Family Home.)

  When to call: when you need a fast, clean cash sale with no repairs, no showings, no commissions, and no clearing out the “stuff” first.

Financial Planning

Care costs money, and the professionals in this group are the ones who help you make the money work: from the overall plan to the taxes, the insurance, the short-term loan, and the equity sitting in the house.

• Financial Planners

  Offer services that address the unique and evolving financial, demographic, health, and emotional needs of seniors and their evolving needs. (See Chapter 10: Funding Strategies to Pay for Immediate Needs.)

  When to call: when you want a professional eye on how care costs fit the family’s financial picture over the long term.

• Tax Planners

  These professionals have a keen understanding of the operational, compliance, and strategic planning issues and are a great resource for senior care planning.

  When to call: when a sale, an inheritance, or care expenses raise tax questions you cannot answer on your own.

• Insurance Brokers/Agents

  They offer services such as long-term care insurance, long-term care riders, life insurance conversions, and annuities, any of which could be used to help pay for senior care.

  When to call: when you want to know whether an existing policy, a rider, a conversion, or an annuity can help pay for the care your family needs.

• Lenders

  Help with short-term loans known as bridge loans can be used until a senior secures permanent financing or removes an existing obligation. Bridge loans are up to one year, have a little higher interest rate and may be unsecured or backed by some form of collateral, such as real estate.

  When to call: when a short-term bridge loan can cover the gap between today and permanent financing.

• Reverse Mortgage Brokers

  They issue a mortgage loan, usually secured by a residential property, that enables the senior to access the equity of the property. (See Chapter 10: Reverse Mortgages.)

  When to call: when the home is the largest asset and you want to tap its equity without selling it.

Additional Support and Care Providers

Finally, there are the people who show up in the everyday: the ones who help after a hospital stay, the ones who care one-on-one, and the ones who make the physical move possible.

• Social Workers

  These professionals collaborate with patients, their families, and their care team to promote physical and mental well-being following an illness, hospitalization, or other medical event.

  When to call: after an illness or hospital stay, when the whole family needs support for their emotional well-being, not just the patient’s.

• Private Duty Nurses

  Registered nurses (RN) or licensed practical nurses (LPN/LVN) who works one-on-one with individual patients and/or their families. Many provide their services at the homes of their patients.

  When to call: when your loved one needs one-on-one skilled nursing, often right in the home.

• Hospital Discharge Workers

  These individuals help coordinate the information and care you’ll need after you leave the hospital.

  When to call: before you leave the hospital, so you know exactly what care comes next and who will provide it.

• Home Health Care Agencies

  They connect families with pre-screened caregivers that match the care needs of your loved one or parent.

  When to call: when care at home is the plan and you need vetted, pre-screened caregivers matched to the actual need.

• Downsizing Experts

  Estate sale companies and specialists who can offer resources and tips and help you deal with all the “stuff” as you prepare to sell a home.

  When to call: when you are preparing to sell and the decades of “stuff” stand between the house and the market.

Putting the Lineup Together: Who Do You Call First?

Once you know the players, the order almost plays itself. Here is the short version of who to call first:

1. 1. The hospital discharge worker, if your loved one is still in the hospital

   They coordinate the information and care you’ll need after discharge, so they are the first person to ask about the next seventy-two hours.

2. 2. A geriatric care manager, for the assessment

   A licensed nurse or social worker who specializes in geriatrics acts as a private advocate and guide, identifying what is really needed before anyone makes a plan.

3. 3. An elder law attorney, for the legal foundation

   Health care, long-term care planning, guardianship, Medicare and Medicaid: the legal pieces are best built before a decision deadline lands.

4. 4. A placement agent, when a community is in the picture

   Free to families, and armed with real relationships with local care communities, they match your loved one to the right option.

5. 5. A VA accredited representative or certified Medicaid planner, for benefits

   Accredited, trained professionals who can help you claim the veterans and Medicaid benefits your family may have earned.

6. 6. The financial team: planner, tax planner, insurance broker, lender, reverse mortgage broker

   One funding puzzle, five specialists: the plan, the taxes, the policies, the bridge loan, and the equity in the home.

7. 7. A Realtor or an “as-is” certified home buyer, when the house enters the plan

   The traditional listing versus a fast cash sale: two paths, both covered in Chapter 10, and the right one depends on time, condition, and goals.

8. 8. The day-to-day crew: care coordinator, social worker, private duty nurse, home health agency, downsizing expert

   These are the people who make daily life work, from supervising care to the move itself, and they slot in once the bigger plan is set.

You do not need to hire all eight at once. Most families start with the first two or three and build from there. The point is that the order exists, and it starts with understanding what your loved one needs before anyone tries to sell you a solution.

Questions families ask us

Here is the honest closing thought: the families who do best in long-term care are the ones who build their team early, before a crisis picks the lineup for them. You do not need to hire everyone on this list today. You need to know who the players are, what each one does, who is free versus paid, and who to call first, so that when the day arrives, you are choosing the team instead of reacting to one.

You can reach Michael at (561) 441-8420, email michael@thecompleterealestateteam.com , or book a time at calendly.com/michaelwisniewski/15-min-strategy-call . If you have a question you would rather ask in writing, the Ask The Wizard hub is open for you.

Chapter 3 of 18: what comes next

This is Chapter 3 of an 18-part series, How To Pay for Long-term Care, which Michael is turning into a book. If you missed the beginning, start with Chapter 1: The Facts , which lays out the statistics and the costs every family should know, then Chapter 2: It’s OK to Be Stressed , which helps with the emotions every caregiver carries. Chapter 4 continues the lineup with the professionals who protect the legal foundation of the plan: elder law attorneys.

For now, take one small, kind step: write down the names of the players you think your family will need, and who you will call first. Knowing the lineup is the first real piece of the plan, and you are already further along than most families ever get.

Talk Soon