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.

You can find gifts for retirees and others at my Etsy Store, DeborahDianGifts:  http://www.etsy.com/shop/DeborahDianGifts

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If you are interested in learning more about Medicare, Social Security, financial planning, common medical issues as we age, where to retire and more, use the tabs or pull down menu at the top of the page to find links to hundreds of additional helpful articles.

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Family Responsibility Laws and Long-Term Care

Did you know that over half the states in the U.S. have family responsibility laws which could make you financially obligated for the nursing home bills of your parents?  Filial responsibility laws could also make your children legally responsible if you need to move into a skilled nursing or memory care facility.  Just as shocking to some people, if one of your children cares for you in their home, your other children could be forced to pay your caregiver child part of the cost of your care.

Which States Have Filial Responsibility Laws?

Family responsibility laws cover over half the people in the United States.  Below is a list of states which currently have filial responsibility laws on the books, although the laws may vary slightly from state to state and are unevenly enforced:

Alaska, Arkansas, California, Connecticut, Delaware, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Maryland, Massachusetts, Mississippi, Montana, Nevada, New Hampshire, New Jersey, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Dakota, Tennessee, Utah, Vermont, Virginia, and West Virginia.

How to Protect Your Family from Filial Responsibility Laws

Fortunately, there are actions you can take to protect yourself and your family from becoming financially liable for nursing home bills incurred by you or your parents.  The most important thing you can do is to have a plan.  Below is a range of possible options.  You only need to choose one.

1.   Put aside money for your future care.  People who have sufficient savings, cash value in their life insurance, or home equity are usually in good shape to pay for their own long-term care, although they may have to borrow against their insurance or home. As a result, they will not pass on the burden for their care to their children.  For example, if your elderly parents have enough money, insurance, or home equity to pay for their care, you will not be responsible for covering the cost, unless they use up all their assets.  At the same time, if you have also accumulated enough savings, you will protect your children from being liable for your care.

2.  Buy long-term care insurance.  Another option is to buy long-term care insurance which will pay for skilled nursing care, memory care, or an in-home caregiver.  The younger you are when you purchase this insurance, the less expensive it is.  You must be able to pass a physical to get it, so it may be too late for some applicants.

3.  Move into a CCRC.  A CCRC is a Continuing Care Retirement Community.  Typically, a senior citizen sells their home to "buy in" to the CCRC.  In addition, they pay a monthly fee which covers their food, housing and normal care.  If they need extra care as they age, they either pay for the extra care when they need it, or the cost is taken from their original "buy in" fee.  The facility guarantees they will be taken care of for the remainder of their life.  If there is money left over from the "buy in" fee at the end of their life, a portion of it will be returned to the family.  In most cases, you must be able to live semi-independently and not need skilled nursing or memory care when you move into the CCRC.  However, you do not need to be in perfect health.  For example, in most cases you can be undergoing treatment for cancer or other illnesses, as long as you are able to walk on your own and live in your own apartment at the time you move into the facility.  This takes a little advanced planning.

4.  Confirm that you are qualified for Medicaid.  If you do not have equity in a home and very few assets, you may qualify to receive Medicaid, a government program which will cover your long-term care.  However, if using Medicaid is your plan, you should make sure you are eligible and that either you or someone in your family is prepared to complete the application as soon as you are admitted to a skilled nursing or memory care facility.  Medicaid is a common way of handling these expenses.  In fact, Medicaid (called MediCal in California) is the most common payer of nursing home expenses in the state of California, as well as many other states.  If the family does not complete the necessary forms in a timely way, however, the family can still be liable for any expenses incurred until they make sure the paperwork has been properly dealt with. Whoever completes the forms will need access to all your financial information, including tax returns and bank accounts, so they can prove that you are eligible.  There is a catch with using Medicaid ... if the patient has recently gifted too many assets to their heirs, they may not qualify until those assets are first used to cover the nursing home costs.

5.  Choose a family member who can care for you in their home.  This is something you need to decide in advance and everyone in the family should be in agreement about who will care for you, which relatives will relieve your caregiver periodically so they can get a break, and how your expenses will be covered while you stay in your family member's home.  It would be helpful to have a family meeting and write out the plan in advance.  It would also be helpful to have a back-up plan, such as Medicaid, in the event your care becomes too much for a family member to handle.  For example, my sister cares for our mother who has dementia.  Our mother has wandered off a few times and fallen on several occasions.  If it becomes impossible for my sister to keep our mother safe, we have all accepted that she may eventually have to move into a memory care facility.

However you decide to handle the long-term care expenses of your parent or yourself, it is important to have a plan so you do not trigger family responsibility laws and leave some other family member saddled with unexpected expenses.

If you would like an overview of retirement planning, watch for my book Retirement Awareness: 10 Steps to a Comfortable Retirement which will be released in 2018 by Griffin Publishing.

For more information on financial planning, where to live after retirement, Social Security, Medicare, common medical problems and more, use the tabs or pull-down menu at the top of the page to find links to hundreds of additional articles.

You are reading from the blog:  http://www.baby-boomer-retirement.com

Photo credit:  morguefile.com

Sources: 

"Filial Responsibility: Can the Legal Duty to Support Our Parents be Effectively Enforced?" by Shannon Frank Edelstone, American Bar Association's Family Law Quarterly, 36 Fam. L.Q. 501 (2002)

"Family-Responsibility Laws Could Cost Your Clients" by Jamie Hopkins, Barron's, April 24, 2017

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 www.medicare.gov. 


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:

• Call 1-800-MEDICARE: www.medicare.gov
• Visit the Medicare and Medicaid Services website www.cms.hhs.gov

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 www1.va.gov/directory/guide/home.asp

 

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

http://www.aplaceformom.com/search

California Nursing Home Solutions

(They handle the Medi-Cal Applications, etc. for you)

(800) 773-6467

http://www.nhscare.com/Home/tabid/1066/Default.aspx

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.

For additional retirement information, use the tabs at the top of this page.  They contain links to hundreds of additional articles on retirement.

You are reading from the blog:  http://www.baby-boomer-retirement.com

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Long-Term Care Insurance -- Should You Buy It?

It may be hard to imagine today, but the time may come when you will have difficulty bathing yourself, getting dressed, preparing meals, eating, moving from the bed to a wheelchair or walker, using the bathroom, remembering to take your medication, or with incontinence.  This situation may come on slowly as we age, or it could happen suddenly as the result of a stroke or accident.  No matter the cause, it is important that you have a plan for dealing with these issues when the time comes.

Cost of Getting Long-Term Care

If you have not properly prepared, obtaining the care you need can be extremely expensive.  Although the exact amount varies across the nation, the Orange County Council on Aging estimates that it can range from $50,000 to $80,000. 

The least expensive type of care is when a family member provides the care you need.  However, this is not always a possibility.  Personally, I know of several widowed, childless men and women.  They have no near relatives who can care for them if they should become incapacitated.

Another option is to apply for MediCal.  This is a government program that covers long-term care expenses for many people.  A company called Nursing Home Solutions provides professional financial planners who can help you see if you qualify for MediCal.  In their ads they say that you do not have to spend down all your assets in order to qualify for MediCal assistance in paying for a nursing home. I am sure there are also other companies that can help you apply for this program.  You can contact Nursing Home Solutions at http://www.nhscare.com/.

The next least expensive type of care is the use of a part-time caregiver in your own home.  The cost becomes more expensive if you need full time care in a nursing home or assisted living facility.

The most expensive care is for those people who choose to have 24-hour caregivers in their own home, since this requires three shifts of caregivers, seven days a week.

What Does Long-Term Care Insurance Cover?

Fortunately, there is a type of insurance that will pay for your care when you are no longer able to take care of yourself.   In California, where I live, these insurance policies must include coverage for in-home caregivers, as well as the cost of residing in an assisted living facility or a nursing home.  This gives you the option to receive your care in the setting that is most appropriate for you and your family.  For example, if your spouse needs long-term care, having this insurance may make it possible for them to stay in your home with you, without forcing you to put them in a nursing home.

Purchasing Long-Term Care Insurance

This type of insurance gives you a variety of options, so different people can choose the amount of insurance they can afford.  You can select a policy that covers your care for a few years, or you can choose one that would cover you for as long as necessary, even if that is the rest of your life.   The shorter the term of care, the lower the premiums will be.

Why Would You Buy a Short Term Policy?

You may be wondering why everyone wouldn't just buy a policy that would cover them indefinitely, rather than have a time limit on it.  Of course, that would be ideal, but it could be too expensive for many people.  When my husband and I purchased our policies, we bought a long-term policy for me, and one that would last a maximum of 4 years for my husband.

Our insurance agent said that you have to look at things practically.  I am more likely to outlive my husband.  If he were to become debilitated, I would probably care for him by myself as long as possible before bringing in a caregiver.  Once we reached that point, four years of long-term care would probably be adequate.

On the other other hand, when I am elderly and losing my ability to care for myself, I probably would not have a spouse to take care of me.  I would need to hire a caregiver sooner and would most likely need the care for the rest of my life.

Based on our conversations with our insurance broker, we purchased the policies that seemed to be affordable and would meet our projected needs the best.  The right policy for you will vary depending on your personal circumstances, such as whether you are single or married, whether or not you have adult children who are capable of providing the care you might need, the health and life expectancy of you and your spouse, and how much insurance you can afford.  Even a short-term policy is better than no long-term care insurance at all.

Whatever you decide, you want to make sure you select a policy that you can afford now, as well as in the future.

What If You Do Not Qualify for Long-Term Care Insurance?

The younger you are when you buy the policy, the better off you will be.  It will be less expensive in your 50's or early 60's and you are more likely to qualify for it.  However, if you do wait until you have a chronic condition and you have trouble qualifying, there are alternatives.  If you or your spouse is a Veteran, you may qualify for $2000 a month in long-term care aid from the Veteran's Administration.  There are also special life insurance policies that include long-term care riders.  You can talk to your insurance agent about those choices.  You may also be able to qualify for MediCal.

Whatever you decide, you need to give this issue some thought and let your loved ones know about any policies you own or money that has been set aside for your long-term care.  You do not want to wait until you are injured and cannot speak for yourself.

If you are retired or planning to retire soon, you will find links to more information about long-term care in the Medical Concerns tab at the top of this page.  You may also be interested in the article links you will find under the other tabs, which cover issues such as financial planning, where to retire, and family isues.

Source:

http://www.nhscare.com/

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Alternatives to Long Term Care Insurance

As mentioned in my last post, "Will You Qualify for Long Term Care Insurance?" more than half of Baby Boomers and older retirees will not qualify for Long Term Care Insurance.  What will happen to them when they become old and frail?

When my husband and I purchased our LTC insurance, our broker told us that I needed more insurance than my husband because I was likely to out-live him.  He said that in the case of a couple, one spouse will often care for the other right up until the time of death.  Many debilitating diseases can be treated at home, as long as there is a willing caregiver who is able to handle this.  Because of this, the first spouse to become ill may not even need LTC insurance, or may only need it for a relatively short time.  We purchased a policy that would provide care for my husband for four years, while we purchased life-time care for me, beginning 90 days from the time I go into a nursing home or need at-home assistance.  (Medicare pays for the first 90 days of care.)

However, what if you are single or widowed and you do not have long-term care insurance?  What if you are married, but you become too old or frail yourself to physically care for an ill spouse?  What if your ill spouse needs more care than you are able to give?  In these situations, you need to know about your options.

Alternatives to LTC Insurance

According to InsuranceNewsNet, people who have liquid assets that exceed $1.5 million could self-insure themselves.  People with adequate assets should be able to personally cover the cost of either a home healthcare aide or a nursing home, should one become necessary.

At the other extreme, people who have very few assets may also want to self-insure.  Currently, a person who collects less than $30,000 a year in individual Social Security benefits is eligible for Medi-Cal, as long as they do not have very many assets.  In this situation, Medi-Cal will cover the cost of a semi-private room in certain nursing homes, or homecare with community based services.  Medi-Cal also protects a spouse from becoming completely impoverished if the other spouse needs to go into a nursing facility or similar medical institution.  However, there are limits on income, assets and home equity and the numbers are changed from time to time.  You can get more information about current eligibility requirement and benefits in this overview of the Medi-Cal program.

For those who cannot afford to self-insure and do not think they will qualify for Medi-Cal, there are a few other alternatives to traditional long-term care insurance.  The particular option that will work for you depends on whether the reason you cannot obtain a policy is because you cannot afford one or because you cannot get the approval of medical underwriters.

What If You Cannot Afford LTC Insurance?

If your income falls in the middle between being wealthy or low-income, you may wish to try one of these other solutions to help cover the expense if you or your spouse needs long term care.

One approach that may be more affordable than traditional LTC insurance is to purchase a special combo policy that combines both life insurance and LTCI.  With these combo policies, you will get a lower return on the cash value of your life insurance and your death benefit may be cut if you use too much of the LTC benefits.  In addition, you still need medical approval.  Therefore, you can be denied this policy, just like you can be denied a traditional LTC policy.  However, for those who do qualify medically but may be concerned about the cost, this may be a less expensive alternative.  Basically, it gives you the opportunity to take an advance on your life insurance in order to pay for your long-term care.

Your insurance broker may also be able to help you with similar options such as a long-term care rider on your current life insurance policy.   Discuss both of these options with your insurance broker to see if this is an affordable, practical option for you.

What If You Cannot Pass the LTCI Medical Exam?

As mentioned in my previous article, more than half of Americans age 50 and older will not be able to qualify to buy this insurance because they cannot pass the strict medical standards.  This is especially worrisome for these people because those who have a serious medical problem are also the same people who are likely to eventually need care, either in their personal residence or in a nursing home.

One option they have is to purchase an annuity with a long-term care rider.  These riders do not require a medical underwriting, but you need to wait five to seven years until the LTC benefit is available.  In addition, you have to have enough assets to pay for them in advance.  Many annuities can require an upfront premium of $50,000.  You should also know that the benefits are only for a limited time.  However, if you believe this would be helpful to you, contact an investment professional who specializes in annuities. 

Another similar choice is to purchase a medically underwritten immediate annuity which can provide you with a lifetime income stream.  With this type of annuity, your income stream may actually increase if you show that you have coronary artery disease or some other serious illness that is likely to shorten your life.  The reason for this is because the insurance underwriters are betting that your disease will reduce the number of annuity payments they will need to make, therefore each payment can be a bit larger.  This may sound grim, but the truth is that there are actuaries who work for the annuity companies and they base the estimated return on your investment on how long they expect you to live. For people who need to dramatically increase their retirement income in order to cover long-term care, this type of policy can be a helpful solution.  Again, talk to your investment professional and find out what types of annuities they offer.  Discuss with them whether you should put your money in this type of annuity now or wait until you are seriously ill and need the extra income.  If they recommend that you wait until you need this annuity, make sure you put aside the money in a safe account, so that you have it when you need it.

Whether you decide to self-insure your long-term care, rely on Medi-Cal,  purchase a LTC insurance rider on a life insurance policy, or buy an annuity that will cover your future medical expenses, will depend on your personal situation.  You should not make a decision on this without consulting your financial planner, investment professional and insurance broker.  Whatever option you decide is best for you, the purpose of this post is to let you know that you do have options.  Even if you do not qualify for traditional Long Term Care Insurance, you are not helpless.  You can still make a plan regarding the way you will pay for your personal care during the last few years of your life.  It provides peace of mind just knowing what you will do when the time comes, so you do not have to make decisions when you are already in need of help.

Don't Forget About Your Veterans Benefits

Approximately one in three Americans are also eligible to receive some aid from the Veteran's Administration.  There are some specific guidelines to qualify so you may want to read my article:  "Are You Eligible for VA Long Term Care Benefits?"  You may be surprised to find that you qualify, especially if you or your spouse served in the military and a war was going on during that period of time ... even for just ONE day.  The veteran did not have to serve in the war zone, just be in the military at that time.  The application process is complicated and they initially deny benefits to most applicants.  Don't give up!  Get help from an organization like the American Legion or Veterans of Foreign Wars.  You may also be able to hire a consultant to help you.  The effort is well worth it!
  

Find additional information about your options at:

http://www.bankrate.com/finance/insurance/long-term-care-insurance-too-pricey-1.aspx

http://www.smartmoney.com/plan/insurance/weighing-the-longtermcare-insurance-alternatives-1348499043403/

If you are looking for more information to help you with your financial and retirement planning, use the tabs or pull down menu at the top of the page. You will find links to hundreds of articles on medical issues, financial issues, places to retire and more.


You are reading from the blog:  http://baby-boomer-retirement.blogspot.com

Photo of elderly couple courtesy of www.morguefile.com

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 www.va.gov.  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 http://medicare.gov/homehealthcompare.

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 www.morguefile.com