Aging and Autonomy

By Mat Snarr, Elder & Disability Law Clinic Student, Spring 2018

The William & Mary Elder & Disability Law Clinic provides services to elderly and disabled clients who are unable to afford the legal assistance they need.  Clinic students often assist clients with planning for long-term care.  Family members facing the decision of how to support aging loved ones understand how tough this can be.  Some of the main considerations are the cost of care and the preservation of individual autonomy.  Commonly, an elderly person is either physically healthy but suffers from diminished mental capacity or is physically incapacitated but mentally competent.

Care services for aging loved ones can place a great financial burden on families.  Currently, the national average cost for long-term care in the United States is $225 a day or $6,844 per month for a semi-private room in a nursing home.[1]  Private insurance and Medicare only cover long-term care in limited situations, and even then, the number of days covered is restricted.  The national average cost for a home health aide is $20.50 per hour.[2]  This cost varies depending on the time of day and the type of services provided.

I recently had the opportunity to work with Jack and Grace, a couple trying to obtain care and preserve their autonomy.[3]  Jack and Grace are both advanced in years but have still managed to care for themselves.  Both require walkers to navigate their residence and Grace often uses a wheelchair.  Recently, Grace’s mental capacity has begun to deteriorate.  Jack’s health has strained his ability to care for her.  Jack sought the Clinic’s help to evaluate options for acquiring home care for Grace through Medicaid.

After meeting with Jack and Grace, I evaluated their medical and financial eligibility for Medicaid.  It quickly became apparent that neither Jack or Grace qualified for the care they wanted through Medicaid.  Although both may be medically eligible for Medicaid, their financial situation made them ineligible.  If they arranged their limited assets to become financially eligible, they would lose their independence.  Due to Jack’s military service, another available option was a VA Pension.  Unlike Medicaid, VA pension deducts unreimbursed medical expenses from its financial eligibility calculations.[4]  If determined eligible, a VA pension could provide additional income to Jack to pay for home care.  After completing a financial analysis, I discovered that Jack was ineligible for a VA pension.

Jack and Grace have worked hard their whole lives to take care of themselves.  They have reached the point where their assets and fixed income preclude them from the benefits that they need.  If Jack and Grace reallocate their resources to qualify for benefits, they will lose their autonomy.  Unlike many people his age, Jack is still able to work part-time.  He hopes that his part-time work will provide the resources he needs to maintain his current living arrangements and provide Grace with the care she needs.  Unfortunately, Jack may be prolonging the inevitable, but that is his decision to make.

Clinic work at the law school is a rewarding experience. I feel great satisfaction in helping clients attain their goals and receive the benefits and legal services they need.  However, situations arise where clients have to make decisions that limit the Clinic’s ability to help them attain their goals.  These cases can be heartbreaking.



[3] Pseudonyms for clients’ actual names.