AREA AGENCY ON AGING
The State of Texas Health and Human Services Commission has designated 28 area agencies on aging (AAA) for the purpose of providing services to help people aged 60 and older, their family members, and caregivers receive the information and assistance they need in locating and accessing community services. Services include:
- Information, referral and assistance
- Benefits counseling and legal assistance
- Care coordination
- Caregiver support services
- In-home support services
- Legal awareness
- Nutrition services
- Ombudsman Program
AAA services are targeted to those with the greatest economic and social needs. Particular attention is paid to people with low-income, older people who belong to minority groups, and older people residing in rural areas. In addition, family members and other caregivers may receive information and services on behalf of the older person for whom they are providing care.
Following is the link to the Texas AAA website, from which a caregiver can search for the agency that serves her region:
Social Security is a federally funded program designed to provide a post-retirement income stream for retirees, disabled citizens, and survivors of both groups. Funded primarily by a payroll tax on workers and their employers, it represents a defined benefit pension plan for eligible participants. To be eligible for retirement benefits, a worker must have worked in a job covered by Social Security.
Many employee groups participate in separate retirement programs (e.g., Texas Teacher Retirement System) and pay into these retirement plans instead of Social Security. Unless they have also worked in a job covered by Social Security, these workers are not eligible for Social Security retirement benefits.
The amount of a worker’s post-employment benefit payment is based upon the income earned while working, the length of time worked, and the age at which benefits begin.
Normal retirement age (once age 65 for everyone) is now determined by a scale that gradually defers the inception date based upon the person’s birthdate. For example, normal retirement age for a person born in 1940 is 65 years and 6 months while a person born in 1960 or later has a normal retirement age of 67 years.
Retirees may elect to initiate Social Security retirement benefits as early as age 62 (for a reduced monthly benefit) or defer its inception to as late as age 70 (and enjoy a bit larger monthly benefit). The decision on when to initiate retirement benefits is a very personal one dependent upon several factors:
- Do you have reason to believe that you will live a shorter (or longer) life than normal life expectancy?
- Do you need the money now?
- Do you fear that the Social Security program will go away someday?
As discussed elsewhere in this guide, the decision to initiate retirement benefits is a very personal one that should be made with the counsel of a professional financial adviser. But certainly, a diagnosis of dementia will color the life expectancy projection that is used in making this decision.
The following is a link to the Social Security website where full details about the program can be viewed:
Even with access to the Social Security website, it can be difficult to digest all the rules and exceptions. For many caregivers, an in-person meeting with a representative from the Social Security Administration (SSA) can be helpful. Although one can walk into an SSA office and request such a meeting during normal business hours, the wait will be much shorter if an appointment is made in advance. Type “Social Security office near me” into your browser to see a list of nearby offices with phone numbers and physical locations.
SSDI is a payroll tax-funded federal insurance program. Although a separate government program, it is managed by the Social Security Administration and designed to provide monthly benefits to people who have a medically determinable disability (physical or mental) that restricts their ability to be employed.
Eligibility for benefits under SSDI is not dependent upon the cause of the disability. Eligibility is based upon two factors: (1) having worked in a job covered by Social Security, and (2) having a medical condition that meets the Social Security definition of disability. In general, SSDI is intended to replace a portion of a worker’s lost wages due to an injury or illness that currently prevents that worker from working at a job.
Unlike private long-term disability insurance (discussed elsewhere in this guide), the Social Security definition of disability is quite restrictive. Not only must one be unable to perform the job he held before becoming injured or ill, but he must also be unable to perform ANY “substantial gainful activity” (i.e., any job that could earn a wage). Still, a dementia patient in the moderate or later stages of the disease will at some point lose enough cognitive functionality to meet this test.
For a detailed description of the SSDI program and instructions on how to apply for it, click here:
Sometimes inaccurately used interchangeably, Medicare and Medicaid are two very distinct federal health care programs with different (but sometimes overlapping) target beneficiaries.
Medicare is a health insurance program for U.S. citizens aged 65 or older and younger citizens with certain disabilities or diseases. There is no means-testing (i.e., limitations based upon income or assets) for Medicare.
Although Medicare is available to all citizens who qualify, one must still make application to be enrolled and receive its benefits. Eligibility starts on the 1st day of the month of the enrollee’s 65th birthday (e.g., born on 9/16/55, eligible on 9/1/2020). Enrollment may begin as early as 3 months prior to eligibility and no later than 3 months after the 65th birthday.
Medicare is divided into four parts:
- Part A covers hospital, skilled nursing, and hospice services.
- Part B covers outpatient services.
- Part C is an alternative that allows patients to choose private plans with different benefit structures that provide the same services as Parts A and B, usually with additional benefits.
- Part D covers prescription drugs
For the purposes of this guide, perhaps as important as what Medicare covers, is what it does NOT cover.
Unfortunately, many caregivers with limited financial resources mistakenly believe that Medicare will pay for the cost of placing their loved one in a senior living community (e.g., assisted living or memory care). It will not. Unless the patient qualifies for Medicaid (discussed elsewhere in this directory) the cost of a senior living community must be paid from long-term care insurance or personal assets.
In addition, Medicare will NOT pay for the following medical services:
- Non-medical care for people with disabilities or chronic illnesses, such as help with dressing, bathing, and toileting
- Routine physical exams (e.g., annual checkups and exams)
- Eye exams for prescribing, fitting, or changing eyeglasses
- Hearing aids or exams for fitting them
- Cosmetic surgery
- Massage therapy
- Routine dental care or dentures
For a complete discussion of the Medicare enrollment process and descriptions of what it does and does not cover, visit the following government website:
Medicaid is a federal government-funded health services program for adults and children with limited income and assets. Although funded by the federal government, Medicaid is actually managed by the individual states. States may (but are not required to) supplement the Medicaid funding they receive from the federal government; thus, the list of services and funding amounts vary widely among states. Texas, for example, ranks somewhere in the middle of the 50 states in Medicaid spending per capita.
Medicaid’s eligibility guidelines are intended to restrict benefits to only the lowest rungs of the country’s socio-economic ladder. To be eligible for Medicaid in Texas, the applicant’s income needs to be less than $2,900/month and personal assets must not exceed $2,000 in value.
Although Medicaid’s eligibility requirements are quite restrictive, once qualified, Medicaid beneficiaries receive access to several benefits not provided by Medicare such as housing, meals, and dental insurance.
For a more detailed description of Medicaid and its benefits for Texas residents, visit this website:
Care for veterans with dementia is provided for a wide range of health care needs through the U.S. Department of Veterans Affairs (VA). Depending on the veteran’s needs, services may include:
- Home health care
- Senior living community costs (e.g., assisted living or memory care)
- Adult day care
- Respite care
- Hospice and palliative care
For a detailed list of potential benefits and contact information, visit the following website:
