Thursday, November 8, 2012

How to Plan for Long Term Medical Care

As we Baby Boomers begin to age, sooner or later two out of three of us are likely to need Long Term Medical Care.  Approximately one of five will need that care for more than five years!  If you are married, the odds are extremely high that either you or your spouse will need assisted living or a nursing home in the coming years.

Long Term Care is Expensive

Unfortunately, the cost of these services is quite high.  For example, according to an article in The Wall Street Journal dated October 27, 2012 and entitled "The Cost of Living Longer," the average basic cost for assisted living in the United States ranges from $2751 to $4807 a month, depending on the number of services needed. In addition to the basic cost, however, patients should plan on paying about $347 for medication management, $236 for dressing assistance, $181 for bathing assistance and $504 for other personal care each month. That means the total cost of total care is approximately $4000 to $6000 a month. The cost of this has gone up about 2 to 4 percent every year since 2012.

It is easy to see that the cost of these services will quickly sky-rocket out of reach for most families.  Fortunately, there are steps we can all take now to make sure our future care is more affordable and less stressful for our other family members.

Buy Long Term Care Insurance

While you are still in your 50's or early 60's, look into the cost of purchasing Long Term Care Insurance from a reputable company like Genworth, one of the country's largest providers of this insurance coverage.  My husband and I purchased this insurance about five years ago, and we are glad we did.  The younger you are when you purchase Long Term Care Insurance, the less you will have to pay in premiums.

However, although this insurance will bring you peace of mind, it only helps if you are able to qualify for it and afford it.  If you wait until you have a serious medical problem you will not be approved or the premiums may be too high.  In those cases, you should look at the other money saving options that may be available to you, and let your family members know your preferences.  Here are some possibilities.

Long Term Benefits from the Department of Veterans Affairs

A war veteran or their spouse may each receive as much as $2020 a month in benefits from the Department of Veterans Affairs to help pay for the cost of assisted living or nursing home care.  When combined with your other retirement benefits, this may be enough to cover the cost of your long-term care. The veteran only needs to have served in the military for at least one day during a war ... including the wars in Vietnam, Korea, etc.  They do not need to have served in a war zone while the war was going on.

If you think you may qualify, you can get more information and help with your application by going to  Then click on "Locations" - "State Veterans Affairs Offices" - "Veterans Service Organizations" or "Regional Benefits Offices."  Unfortunately, I have been told that at many as 60 percent of claims are denied the first time you apply.  If you are denied, you may want to get help with the application from a service organization such as Veterans of Foreign Wars.  Do NOT give up.  You are entitled to these benefits.

Medicaid Long Term Care for Low and Moderate Income Individuals

Many people confuse Medicaid and Medicare.  However, they are different government programs.

Medicare will only pay for the first 100 days of nursing home care.  After that, you are on your own if you have assets and a moderate to high income.

However, Medicaid will pay for most long-term care for low-income and many moderate income people, especially those with very few assets.  In the case of a couple, the spouse who does not need care is allowed to keep some assets, a home and, possibly, a business ... although they may be expected to contribute to the care of the spouse who is in the assisted living facility.

If you believe that you may qualify for Medicaid, you or your family members should apply as soon as you go into a nursing facility for care that is being covered by Medicare.  The people in the facility can help you with your application.  There are also private companies, such as Nursing Home Solutions and A Place for Mom, which can help you with the application and find an assisted living situation, if you qualify. In California, Medicaid is called MediCal.

Independent Living Apartments instead of Assisted Living

Assisted Living can be very expensive and many people do not need that level of care.  As an alternative, some people are moving into independent living apartments that provide local transportation, meals, exercise classes and other services.  Then the family can hire a caregiver who only comes in a couple of times a week or a few hours a day to provide other essential services, such as help with medication, bathing, getting dressed, etc.

To help you compare the cost of home healthcare in your community, use Medicare's Home Healthcare tool at

This choice is very common, for example, in the senior community where I live, Laguna Woods Village. In fact, it is common in most independent living retirement villages. In our community, many seniors stay in a typical condo or move to a high rise within the community known as Rossmoor Towers.  For about $2300 to $2800 a month, an individual or couple in the Towers has a private apartment with a full dinner provided every evening, and weekly housekeeping.  Each condo has a kitchen where the residents or their caregivers can prepare their own breakfast and lunch.  Many of the residents of the Towers share caregivers with their neighbors.  The caregivers arrive in the morning and help different residents with their meals, medications, bathing, dressing, etc.  Even with the additional cost of the caregiver, this arrangement makes it possible for a couple to stay together in their own private residence, even if one of them needs assistance with daily living.  The Towers are also far less expensive than the surrounding skilled nursing facilities.

Home Health Care - Age in Place

Similar to moving to the Towers, some people simply choose to remain in their own home and hire a caregiver to come to their home each day and provide the necessary assistance.  Whether or not this saves money depends on the cost of living in the current residence.  This may not be feasible for someone who lives in an expensive home with a large mortgage or for someone who will need a lot of personal assistance plus the cost of a housekeeper, landscape workers, etc.  However, it has become a popular and affordable option for many people.

Adult Day Services and Respite Care for Those Getting Care at Home

Another alternative is for the person who needs assistance to live with an adult child or other family member.  This can be stressful for the family members who are placed in the role of caretaker.  Consequently, being able to take an elderly person with dementia or other medical problems to adult day care makes it possible for the full time caregiver to work, run errands or just have a break each day.

Whether you use adult day care services or not, you may also occasionally need respite care. It is available in many areas.  Respite care is provided by many assisted living facilities to enable relatives to leave an older adult in their facility for a few days so that their family members can leave town or deal with a family emergency without worry.

Inform Your Adult Children or Other Relatives of Your Preferences

Once you decide on the type of care that you would like to receive when you are older, it is important that you inform your spouse, adult children or other relatives of your desires.  If you have purchased Long Term Care Insurance, give a copy of your policy to your nearest relative in case you are incapacitated.  If you know of independent living apartments that appeal to you or where you already have friends, inform your relatives of your selection.  If you would like to continue to live in your home as long as possible, others will need to know this, as well.  Finally, if you hope to live with your adult children or other relatives, you should discuss this possibility with them long before you become disabled.

If you would like additional information about where to retire, common medical issues as we age, changing family relationships or financial planning, use the tabs or pull down menu at the top of the page to find links to hundreds of additional articles.

You may also be interested in reading:

Healing Relationships with Your Adult Children
Patient Safety in the Hospital Near You
Laguna Woods Village Active Adult Community
Garden Spot Village Community for Seniors in PA

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Photo of private room in medical facility courtesy of


  1. This is an extensive and valuable list of options. The costs above the basic care are astronomical so it's great to know what other options are available. Thanks for providing them.

  2. My dad died when he was 57, and after caring for him, my mom, who was 55, bought long-term health insurance so I would never have to do what she did. I am grateful for that-it really is a gift to your kids. Great article!

    1. Thank you for sharing your personal experience with this, MommyMommyMommy. We have also known people who have had to care for elderly relatives and often it has taken a great physical, emotional and finanial toll on them. My husband and I decided that long-term care insurance was one of the most caring things we could do for our kids. However, I know many people have either waited too long or cannot afford it. That's why I thought it was important for everyone to know about the other options available. Again, thanks for sharing.

  3. Thanks for the great information on this post.


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