Your home is where you want to stay. And if you're old enough to have grandchildren or be a retiree, you've probably recruited help to make it easier to remain there: You hired people to cut the grass, snowplow the driveway, and clean the house. Your supermarket delivers your groceries. You book rides with Lyft or Uber.

You'll need more help in years to come. You could ask someone to prepare your meals or deliver them to you. Someday you might start to use a walker. You might need an aide to help in the bathroom. Then your children will ask the question you don't want to hear: Would you be safer in a nursing home? You will reply that you would do anything to stay home.

Perhaps you could. MassHealth, the agency that pays 65 percent of the nursing home bills in the state, has funds to pay aides, nurses, and physicians to keep you in your house and out of a nursing home. MassHealth also connects seniors with outpatient clinics that specialize in geriatric care.

MassHealth started to subsidize in-home care because it is evident that old folks are happier and healthier if they are given the option to stay home. MassHealth's funding for in-home care is both humanitarian and pragmatic. Paying for nursing homes already consumes more than 1/3 of Massachusetts' total government spending, a share certain to expand as the population ages. Paying for nursing homes is only half of the challenge. There aren't enough nursing home beds for all the folks who would need them.

MassHealth funding for in-home care is not for everyone. MassHealth limits in-home support in the same way it limits nursing home funding: To qualify for MassHealth, a senior citizen cannot have more than $2000 to his or her name but can have an income.

If you remain in your home, MassHealth gives you more flexibility than it gives to those in nursing homes. If you're a stay-at-home applying for MassHealth, you are free to transfer assets to a trusted family member who may spend from these assets for your benefit. Think of it as your private supplement to the subsidies the state provides. Your healthy spouse will have an asset limit of about $138,000 but can continue to earn income from work, an IRA, or pensions without any impact on MassHealth's funding of your in-home care. The parameters set by the Commonwealth are varied and complex; you might consult an elder law attorney to get an accurate sense of the benefits you could receive.

If you need nursing home-level care but don't want to move out of your house, you could apply for MassHealth's Home- and Community-Based Services Waiver. It pays for health aides who come to your home. You could also apply for the Program of All-Inclusive Care for the Elderly (PACE), which provides all your medial services at no cost to you. Senior citizens who qualify for MassHealth could join Senior Care Options, a no-cost health insurance plan. MassHealth pays monthly premiums that provide an outpatient network with a primary care physician, nurses, medical and geriatric specialists, and transportation for medical appointments.

MassHealth's PACE and Senior Care Options are not a gift from the Commonwealth. They are a loan: MassHealth becomes your creditor. Upon your death, it will seek repayment from your estate in probate court. Had you planned in advance with an elder law attorney, some assets, such as your house, would not be in probate after your death, and could pass to your survivors instead of to MassHealth. Your attorney can discuss different strategies to protect your assets and show that inevitably each has limitations. But the worst plan is no plan.

A nursing home need not be inevitable. Perhaps MassHealth could help you to remain near your family in the house your grandchildren like to visit. Stay home and let others come in to help you. Your life will be happier. And perhaps longer.



PHILIP ARCIDIACONO, ESQ., IS THE PRINCIPAL OF ARCHDEACON LAW ASSOCIATES, A LAW FIRM IN CONCORD AND LUNENBURG, MASSACHUSETTS THAT SPECIALIZES IN ELDER LAW. HE CAN BE REACHED AT PA@ARCHDEACONLAW.COM. THE FIRM'S WEBSITE IS WWW.ARCHDEACONLAW.COM.