Showing posts with label affordable long term care. Show all posts
Showing posts with label affordable long term care. Show all posts

Friday, August 20, 2021

Long Term Care Options for End of Life Care

Are you prepared for the last few years of your life?  Many people do not want to even think about what will happen if they become ill and can no longer take care of themselves. Others assume that their spouse or their adult children will be able to care for them.  However, are you sure your spouse or children are actually capable of lifting you if you fall, help you shower, keep you safe if you lose your memory, or deal with insulin injections or home dialysis?  Unless they are already in the healthcare business and know what they are doing, this may be more than they can handle.

Everyone should anticipate that they will need extra care during the last few months or years of their life.  While some people do die a sudden, unexpected death, it is far more common for people to spend the last few years of their life in a frail condition, dependent on others to care for them.  Who will be able to care for you?  How will you pay for it?

Before you make any decisions, you may find it helpful to read: "How to Care for Aging Parents: A One-Stop Resource for All Your Medical, Financial, Housing and Emotional Issues."   The more you know about your options, the easier it will be for you to make an informed decision for yourself and/or your parents.  

Below is a rundown of the most common options people have for paying for long-term care. 

Will Medicare Pay for My Care? 

If you assume that Medicare will pay the cost of your medical care during the last few years of your life, you will be disappointed.  If you spend at least three days in a hospital, Medicare will cover up to 100 days of needed care in a Medicare approved nursing facility.  After that, Medicare will no longer continue to pay and you will have to make alternative financial arrangements.  If Medicare determines that your illness does not require you to stay for the full 100 days, then you may not even be covered for that long. 

What about Medicaid?

Medicaid (called MediCal in California) is an option for low income people with few assets.  You have to apply for this coverage and meet their financial and medical qualifications.  Many experts suggest you apply for Medicaid the minute you or your loved one enters a nursing home, to see if you qualify financially.  If Medicaid will cover your expenses, it will remove a huge burden from you and your family. 

Should You Self-Insure for Your Long-Term Care?

If you have enough income and assets to cover assisted living or a lengthy nursing home stay for both you and your spouse, you probably do not need to worry about the cost of long-term care.  You can pay out-of-pocket when and if one or both of you need to go into a nursing home for the last few months or years of your life.  However, most people do not have sufficient assets to feel confident they could pay for all the care they need for an indeterminant length of time. 

What About Middle Income People?

The group which has the most significant problem covering the cost of long-term care are those in the middle class.  These are the people who have too much income and savings to qualify for their care to be paid for by Medicaid, but not enough savings to pay out-of-pocket for a lengthy stay in a nursing home.  What options do they have?  How can they prepare for the final years of their lives?

Purchase Long-Term Care Insurance as Early as Possible

One good option is to purchase a long-term care insurance policy, which will pay an inflation adjusted amount of money per day for your care for the length of time you believe you will need that care.  The younger you are when you purchase a long-term care insurance policy, the lower the premiums will be.  You can prepare for the future by purchasing a policy in your 50s, while you and your spouse are both in good health.  There are a variety of types of policies, including some which allow couples to share a policy.  You can also buy policies for varying lengths of time.  For example, you could get two or three years of coverage, or lifetime coverage. 

Your long-term insurance will begin paying for your care at the time you are no longer able to handle at least two of the following basic activities of daily life, which include dressing yourself, feeding yourself, toileting, safely bathing or showering, or transferring yourself out of a bed or chair.  A nurse may be sent to evaluate you before the insurance company will pay the claim. Depending on your policy, you may be able to have a caregiver come to your home, or you may be able to move into an assisted living facility or nursing home. The insurance carrier has to approve your plan. 

The advantage of these policies is that they bring you peace of mind and will help cover your expenses if you should become incapable of caring for yourself.  The disadvantage is that the premiums could rise, even if you start with a low premium.  One way to deal with rising premiums is to cut back on the amount the company may have to pay out by reducing your years of coverage, the daily rate they will pay, or the inflation factor they are using.   

Combination Life Insurance and Long-Term Care Insurance Policy

Another option is to purchase a life insurance policy which will allow you to draw on some of the value of your future death benefits to pay for long-term care.  If you never need long-term care, your heirs receive the full face value of the life insurance.  If you need some of the money for your long-term care, you can use some of the funds while you are still alive.

Move into a Continuing Care Retirement Community

Another option is to move into a CCRC or Continuing Care Retirement Community.  This usually requires you to sell your current residence and purchase a condo or cottage in the CCRC.  You pay the CCRC a monthly fee in addition to the "buy-in" you paid for your condo when you moved into the community.  In return, they guarantee they will take care of you for the rest of your life.  

Most of them require you to be in good enough health at the time you move in that you are "ambulatory" or able to walk on your own and do not need any immediate assistance caring for yourself.  As a result, do not wait until you are already seriously ill before deciding to move to a CCRC.  The CCRC provides you a place to live, meals, maid service, social activities and other amenities.  If you need future nursing home care or memory care, they will provide that, as well.  When you die, they will pay your heirs part of the remaining value of the condo, but it will be less than the price you paid when you purchased it.  How much your heirs receive is determined, in part, by how much the CCRC has spent on your lifetime care.

Plan Ahead and Plan Early

You may also find it helpful to read: "How to Care for Aging Parents: A One-Stop Resource for All Your Medical, Financial, Housing and Emotional Issues."   ABC News referred to this book as the Bible of eldercare and it also received high reviews from AARP and other sources. 

As you can see, you have a number of options which will help you prepare for the future without depending on your children or other family members to care for you.  What is important is that you start looking at your options while you are in your 50s or 60s, and then take the necessary steps to follow the plan which seems wisest for your situation.  For example, visit the Medicaid approved nursing facilities in your area and see if you are likely to qualify to live in one; if not, make arrangements to purchase a long-term care insurance policy.  You may also want to visit the CCRC's in your community and see which one appeals the most to you and how much it would cost to purchase a condo or rent an apartmnt in one.  Once you have a plan, you will worry much less about what the future has in store for you.

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Wednesday, April 1, 2015

Long-Term Care for Low Income Retirees

In other posts on this blog, we have discussed the reasons why people may benefit from purchasing Long Term Care insurance, the various alternatives to this insurance, and the Veteran's Administration benefits that could help you pay for assisted living or nursing home care.

What if none of these options will work for you?  Perhaps you cannot afford long term care insurance or poor health prevents you from passing the physical.  You may not have served in the military, at least not when a war was going on, so you do not qualify for VA benefits.  

In addition, Medicare is not an option because it will only pay for short-term care, such as when you need to spend a few weeks in a rehabilitation facility after you have surgery.  

Do not give up on your ability to find affordable long-term care, however.  If none of the above programs are an option, there are other choices which can help the low-income elderly pay for permanent care, once they reach a point in their lives when they are declining physically and/or mentally.

First, a significant number of the elderly are eligible for long-term care through Medicaid.

Who is Eligible for Medicaid?

In order to be eligible to receive long-term care and have it paid for by Medicaid, you need to meet these criteria:
  1. You have to be willing to apply all of your existing assets towards your care.  This is usually not an issue for people who have few remaining assets and are approaching the end of their lives.
  2. You must have a low retirement income, which applies to nearly everyone living solely on the average amount of Social Security.  Even if your retirement income is greater than the median Social Security payment, you may still qualify if you have high medical expenses.
  3. In the case of a married couple, they do NOT need to exhaust all their financial resources in order for one of them to have their long-term care covered by Medicaid. In most cases, the healthy spouse can keep their home and certain other assets, although they may still have to make significant sacrifices in order to contribute to their partner's care.

Medicaid for Ailing Elders

Medicaid is designed to be a safety net for Americans who need more care than they can afford to pay for privately. Medicaid can be used to pay for long term nursing home care in all states. In a number of states,  Medicaid will also pay for assisted living communities or other options such as in-home care. 

In some states, residents can even access Medicaid through a program called PACE (Program of All Inclusive Care for the Elderly).  PACE will cover all of the senior's care and medical needs through a single agency.  The goal of PACE is to help people who have traditionally been sent to nursing homes to stay at home, with support.  You can learn more about that program at 

State Medicaid Guidelines

Every state has its own guidelines, requirements and paperwork, so you will need to contact your State Medical Assistance office for more details about how their programs work.  Here are two websites that can help you:
You may also want to speak with an elder law attorney who can help guide you through the complicated process of completing a successful Medicaid application.


Veteran's Aid Can Help Both Veterans and Their Spouses

Don't forget that there are also programs to help Veterans who have served in the military during a time when our country was at war.  Many widows and widowers of veterans are not aware that they may also be able to receive benefits to help cover long-term care.


How to Apply for VA Benefits

Like Medicaid, the application process for your VA benefits can be extremely complicated.  To get help, you may want to contact a Veteran Services Officer. They are volunteers who are located throughout the United States,  and you can find them through organizations like the American Legion, or Veteran of Foreign Wars (VFW) lodges.

To apply for VA health care or determine eligibility,
  • Call (877) 222-VETS: Health Benefits Service Center
  • Contact your local Veterans Benefits Office or Medical Facility
  • Visit the Department of Veterans Affairs website


How to Find the Right Assisted Living or Nursing Home Program

How can you find the right program or facility to take you or your loved one?  Where do you start?  How can you get help completing the complicated applications necessary in order to get Medicaid or MediCal to pay for your care?  There are companies that will help you find an available bed in the appropriate facility and they will often assist with the application process, as well.  Here are two well-known companies:

A Place for Mom
(866) 344-8005

California Nursing Home Solutions
(They handle the Medi-Cal Applications, etc. for you)
(800) 773-6467
In addition, you may want to contact nursing homes, assisted living facilities or senior centers in your area and ask if they can help you with the MediCal or Medicaid application process.  Many of them can walk you through the process or they can refer you to a specialist who can help you.

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