To be a free resource for Baby Boomers and Senior Citizens regarding Medicare, Medicaid, Medigap policies, Discounts for Senior Citizens and other essential information for independent living.
Long-term care is a variety of services and supports to meet health or personal care needs over an extended period of time. Most long-term care is non-skilled personal care assistance, such as help performing everyday Activities of Daily Living (ADLs), which are:
·Bathing,
·Dressing,
·Using the toilet,
·Transferring (to or from bed or chair),
·Caring for incontinence, and
·Eating.
The goal of long-term care services is to help you maximize your independence and functioning at a time when you are unable to be fully independent.
As more and more Americans begin to think of retirement and their golden years, the skyrocketing costs of nursing homes and assisted living facilities threaten to financially cripple many Americans who have worked for so hard and so long to provide both for their retirement and for a nest egg for their children. This is one of the many reasons, as you begin to think of retirement, that you should consider owning a long-term care insurance policy.
The statistics are startling. After age 65, most people have a 50% chance of needing long-term care. This is far more than the one-in-1200 chance of needing your homeowners insurance or a one-in 250 chance of using your auto insurance. One-in-two people who have long-term care will use it, and it is the one insurance that you are least likely to have. This is why you should have long-term care insurance, even if you are in good health now
About 70 percent of individuals over age 65 will require at least some type of long-term care services during their lifetime. Over 40 percent will need care in a nursing home for some period of time. Factors that increase your risk of needing long-term care are:
·Age - The risk generally increases as you get older.
·Marital Status - Single people are more likely to need care from a paid provider.
·Gender - Women are at a higher risk than men, primarily because they tend to live longer.
·Lifestyle - Poor diet and exercise habits can increase your risk.
·Health and Family History - also impact your risk.
It is difficult to predict how much or what type of care any one person might need. On average, someone age 65 today will need some long-term care services for three years. Service and support needs vary from one person to the next and often change over time. Women need care for longer (on average 3.7 years) than do men (on average 2.2 years). While about one-third of today's 65-year-olds may never need long-term care services, 20 percent of them will need care for more than five years.
If you need long-term care, you may need one or more of the following:
·Care or assistance with activities of daily living in your home from an unpaid caregiver who can be a family member or friend;
·Services at your home from a nurse, home health/home care aide, therapist, or homemaker;
·Care in the community; and/or
·Care in any of a variety of long-term facilities.
Generally, services provided by caregivers who are family or friends are unpaid. This is sometimes called informal care. Paid services are sometimes referred to as formal services. Paid services often supplement the services provided by family and friends.
Long-term care is needed when you have a chronic illness or disability that causes you to need assistance with Activities of Daily Living. Your illness or disability could include a problem with memory loss, confusion, or disorientation. (This is called Cognitive Impairment and can result from conditions such as Alzheimer’s disease.)
This year, about 9 million Americans over the age of 65 will need long-term care services. By 2020, that number will increase to 12 million. While most people who need long-term care are age 65 or older, a person can need long-term care services at any age. Forty (40) percent of people currently receiving long-term care are adults 18 to 64 years old.
Many people who need long-term care develop the need for care gradually. They may begin needing care only a few times a week or one or two times a day, for example, help with bathing or dressing. Care needs often progress as you age or as your chronic illness or disability become more debilitating, causing you to need care on a more continual basis, for example help using the toilet or ongoing supervision because of a progressive condition such as Alzheimer’s disease.
Some people need long-term care in a facility for a relatively short period of time while they are recovering from a sudden illness or injury, and then may be able to be cared for at home. Others may need long-term care services on an on-going basis, for example someone who is disabled from a severe stroke. Some people may need to move to a nursing home or other type of facility-based setting for more extensive care or supervision if their needs can no longer be met at home.
CURRENT NURSING HOME COSTS-the average cost of a nursing home, today, is $5,000-$10,000/month. And New York has costs already exceeding $130,000 per year. Married couples are more likely to need the benefit because if you price some nursing homes in your area, you need to ask a serious question of yourself. What would happen to your spouse if they had to pay for their standard living expenses as well as the nursing home costs?
CURRENT ASSISTED LIVING COSTS-to live in an assisted living facility, where the level of care is not as intensive as a nursing home, the costs are still significant and can run up to $50,000 per year for a quality, one-bedroom residence at one of these facilities.
CURRENT HOME CARE COSTS-the national average cost of part-time basic home care runs about $16-$17 per hour. Skilled care provided by a nurse is more expensive than care provided by a home health aide. Both costs vary based on the number of days per week the caregiver visits, the type of care required and the length of the visit.
The ideal time to buy long-term care insurance is when you are in your late 50’s, even though the average age of entry into a nursing home is age 84. This is because:
·The costs could be prohibitive later on
·Your health may prevent you from qualifying later in life for the coverage
·Once you are in your late 50’s, you will have a fairly good idea of what you are able to afford in retirement
Depending on the policy, a policy is triggered when a client cannot perform a certain number of the Activities of Daily Living (ADL’s). Some policies trigger when the insured cannot perform 2 of the ADL’s and for others it is more so you need to check with your financial advisor with an elder-care specialty for what would be best for your situation.
·Bathing
·Continence-the ability to retain a bodily discharge voluntarily
·Dressing
·Eating
·Toileting
·Transferring-moving into or out of a chair, bed or wheelchair
·A daily benefit that reflects the cost of managed care facilities in your area. This can be anywhere for $150 per day to $300 per day.
·An elimination period (the deductible you need to pay before the policy benefits activate) of 60 days or less
·An inflation option that will take into account the rising costs of long-term care
·Home health coverage-this is care that is provided in shorter periods while one recovers from an accident or an illness at home
·That the benefits offered in the policy do not exclude a pre-existing condition
·Also, many employer-offered policies may be cheaper than individual plans, but they tend to have longer elimination periods, a limited benefits period, poor inflation protection and no spousal discounts
The basic activities of daily living consist of these self-care tasks:
·Bathing
·Dressing and undressing
·Eating
·Transferring from bed to chair, and back
·Voluntarily control urinary and fecal discharge
·Using the toilet
Long-Term Care insurers use the six guidelines as ‘triggers’, to denote when the benefits of your long-term care policy will kick in. It is important for you to check with your long-term care insurer, or to compare long-term care policies, so that you completely understand which of the ADL’s listed above would trigger your benefits under a particular long-term care policy.
It's difficult to predict if or how much care you will need, whether you will have family or friends who can provide some or all of your care, and how much care may cost you. However, it's reasonably easy to predict that if you need extensive long-term care services or need services over a long period of time, you will have to pay for some or all of it out of your personal finances. That's why an increasing number of people are using private financing options to help them pay for long-term care if and when they need it.
Private long-term care financing options include long-term care insurance, trusts, annuities, and reverse mortgages. Which option is best for you depends on many factors including your age, your health status, your risk of needing long-term care, and your personal financial situation. The following charts summarize how age and health status may affect your eligibility for and choice of private financing options.
An important part of planning for long-term care is deciding how to pay for services. This is because long-term care is very expensive, and contrary to what many people believe, their Medicare coverage will not pay for most of the long-term care services they need. While some people may qualify for Medicaid – the major payer of long-term care services, most people won't. There are other federal public programs, such as the Older Americans Act, or state funded programs, that pay some long-term care services, but like Medicaid they target those people with the most functional and financial need. Consequently, if you are one of the 70% of people over the age of 65 who will need long-term care services – there's a very good chance you will have to pay for some or all of your long-term care services out of your personal income and resources.
Paying for long-term care out of your personal income and resources can be challenging. Even if you have a modest need for assistance at home with personal care, say a visit from a home health aide 3 times a week, based on 2008 average costs, you would have to pay about $18,000 a year for those services.
To make the best decisions about how to pay for long-term care you need to understand what services cost, what public programs you are eligible for and what they cover, what private financing options are available, and which ones work best for you.
The average costs in the United States (in 2008) are:
·$187/day for a semi-private room in a nursing home
·$209/day for a private room in a nursing home
·$3,008/month for care in an Assisted Living Facility (for a one-bedroom unit)
·$29/hour for a Home Health Aide
·$18/hour for a Homemaker services
·$59/day for care in an Adult Day Health Care Center
As of January, 1997, your premiums can be tax-deductible under the Health Insurance Portability and Accountability Act of 1996. But you need to check with an accountant or financial planner with an elder-law specialty to see if a particular policy you are considering would qualify.
Long-term care is expensive. One year of care in a nursing home, based on the 2008 national average, costs over $68,000 for a semi-private room. One year of care at home, assuming you need periodic personal care help from a home health aide (the average is about three times a week), would cost almost $18,000 a year.
Costs for long-term care services vary greatly depending on the type and amount of care you need, the provider you use, and where you live. For example, many care facilities charge extra for services provided beyond the basic room-and-board charge, although some may have “all inclusive” fees. Home health and home care services are usually provided in two-to-four-hour blocks of time referred to as “visits.” An evening, weekend or holiday visit may cost more than a weekday visit. Some community programs, such as adult day service programs, are provided at a per-day rate, and rates may differ based on the type and variety of programs and services offered.
Consumer surveys have revealed some common misunderstandings people have about which public programs pay for long-term care services. Many people believe they can rely on Medicare to pay for any long-term care services they will need. However, Medicare only pays for long-term care if you require skilled services or recuperative care for a short period of time. Medicare does not pay for what comprises the majority of long-term care services – non-skilled assistance with Activities of Daily Living.
Medicaid is the joint Federal and state program that pays for the largest share of long-term care services, but only if you meet financial and functional criteria. Other Federal programs such as the Older Americans Act and Veterans Affairs pay for some long-term care services, but only for specific populations and in specific circumstances.
Most forms of employer-sponsored or private health insurance, including Health Maintenance Organizations (HMO) or managed care, follow the same general rules as Medicare. If they do cover long-term care, it is typically only for skilled, short-term, medically necessary care. Therefore most people who need long-term care end up paying for some or all of their care on their own out of their income or assets.
There are, however, an increasing number of private payment options that help to cover the costs of long-term care services. These include long-term care insurance, reverse mortgages, and other options.
It is important to understand the differences among the public programs and private financing options for long-term care services. Each public program and each private financing source has its own rules for what services it covers, eligibility requirements, co-pays, and premiums.
There are a number of public programs that provide help paying for long-term care services. Each program has specific rules for what types of services it covers, how long one can receive services, eligibility for coverage, and, in some cases, cost sharing. For example, some programs, such as the Older Americans Act, focus on home- and community-based services, while the Medicare program only pays for some short-term nursing home stays or home health care. The following section provides information on some of the major public programs that may help pay for long-term care services.
The Department of Veterans Affairs (VA) may provide long-term care for service-related disabilities or for certain eligible veterans. In 1999, the Veterans Millennium Health Care and Benefits Act expanded VA health programs to include many that may be of use to aging veterans with long-term care needs. The Act requires the VA to provide long-term care to veterans who meet established disability criteria, or to those who need care because of service-connected disabilities.
This bill expands access to nursing home care and other extended care services to veterans who do not have service-related disabilities, but who are unable to pay for the expenses of necessary care. For those who qualify, the benefits can provide financial assistance for some long-term care costs. Co-pays may apply depending on the veteran's income level. Middle-class veterans who need long-term care for non-service-related conditions may find it difficult to access VA benefits for long-term care.
The VA also has a Housebound and Aid and Attendance Allowance Program that provides cash grants to eligible disabled veterans and surviving spouses in lieu of formally provided homemaker, personal care and other services needed for assistance in Activities of Daily Living and other help at home.
The Older Americans Act is a Federal program designed to organize, coordinate, and provide home and community-based services to older adults and their families to help elders remain in the community as independently as possible.
The Older Americans Act provides funding, through state and local agencies known as the Aging Network, for a range of services that include nutrition programs in the community and for homebound elderly; programs for Native American elders; services for low-income minority elders; health promotion and disease prevention activities; in-home services for frail elders; services that protect the rights of older persons such as the long-term care ombudsman program; and services and supports for family caregivers. While there are no specific financial eligibility criteria for Older Americans Act services, they are generally targeted for low-income, frail seniors over age 60, and minority elders and seniors living in rural areas.
Local agencies, called Area Agencies on Aging (AAAs), in collaboration with State Agencies on Aging, plan and develop service and support programs based on the needs of elders and families in their respective areas.
The Medicaid program was enacted by Congress in 1965 in the same legislation that created the Medicare program. Medicaid is a state-administered program overseen at the Federal level by the Centers for Medicare & Medicaid Services (CMS). Specific program limits are set through a combination of Federal requirements and options, giving states flexibility in the design of their programs. As a result, standards and rules vary considerably from state to state.
Medicaid was originally designed to provide health care to poor families, children, the aged, and the disabled. Over time, the number of people served, as well as the cost of serving those people, has increased dramatically. A large part of that growth has been the number of people receiving long-term care services and the cost of providing those services.
The most common types of long-term care that Medicaid pays for are institutional care and home- and community-based service.
Medicaid is a joint Federal and state government program that helps pay medical costs for some people with limited incomes and resources. People with Medicaidmay get coverage for services such as nursing home and home health care, if they meet the eligibility requirements for Medicaid. Who is eligible and what services are covered vary from state to state. Most often, eligibility is based on your income and personal resources, but for coverage of long-term care services, you must also meet certain health or functional criteria to be eligible.
Sometimes you must spend down (or use up) your personal resources (assets) before you qualify for Medicaid. You may want to get more detailed information from your State Medical Assistance office or an attorney before spending down your resources.
Medicare is a Federal program designed to cover health care for people age 65 and older, people under age 65 with certain disabilities, and people of all ages with end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant.) It only covers medically necessary care and focuses on medical acute care (doctor visits and hospital stays) or short-term services for conditions expected to improve.
Generally, Medicare does not pay for most long-term care. Medicare does not pay for personal or custodial care (help with Activities of Daily Living), which is the greatest part of long-term care services.
Medicare will help pay for a limited skilled nursing facility stay, hospice care or home health care if you meet certain conditions, which are described below. Medicare will pay for care in a skilled nursing home when:
·you have had a recent prior hospital stay of at least three days,
·you are admitted to a Medicare-certified nursing facility within 30 days of your prior hospital stay, and
·you need skilled care such as skilled nursing services and/or physical or other types of therapy.
If all these conditions are met, Medicare pays a portion of your costs for up to 100 days. For the first 20 days, Medicare pays 100 percent of your skilled nursing facility costs. For days 21-100, you pay your own expenses up to $128/day (as of 2008) and Medicare pays the balance, if any. You pay 100 percent of costs for each day of a skilled nursing facility stay after day 100.
Medicare payments for home health care are limited to reasonable and necessary part-time or intermittent skilled nursing care and home health aide services as well as physical therapy, occupational therapy and speech-language pathology that are ordered by your doctor and provided by a Medicare-certified home health agency. It also includes medical social services, durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers), medical supplies, and other services. Unlike nursing home services, there is no co-pay for home health. There is also no limit on the duration of service as long as services continue to be medically necessary and your doctor requests or reorders these services at least every 60 days. Hospice care is covered for people with a terminal illness, generally individuals who are not expected to live more than six months. Services include drugs for symptom control and pain relief, medical and support services from a Medicare-approved hospice provider, and other services not otherwise covered by Medicare (such as grief counseling). Hospice care is usually provided in your home (which may include a nursing home if that is where you live) or in a hospice care facility. However, Medicare does cover some short-term hospital and inpatient respite care ¾ care provided to a hospice patient to allow the usual caregiver to rest.
Long-term care, often associated with institutional care, is provided in many different settings. But, most long-term care is actually provided at home – either in the home of the person receiving care or at a family member's home. It’s estimated that individuals currently turning 65 may need 3 years of long-term care in their lifetime, with almost 2 years of that care provided at home. The majority of care that is provided at home – about 80% - is provided by unpaid caregivers. There is also an increasing amount of long-term care available in the community through programs such as adult day service centers, transportation services, and home care agencies that often supplement care at home or provide respite for family caregivers.
For people who cannot stay at home, but who do not need the level of care provided in a nursing home, there are a variety of residential care settings, such as assisted living, board and care homes, and Continuing Care Retirement Communities (CCRCs). Nursing homes provide long-term care to people who need more extensive care, particularly those whose needs include nursing care or 24-hour supervision in addition to their personal care needs.
There are numerous types of facility-based programs that provide a range of long-term care services. Some facilities provide only housing and related housekeeping, but many also include help managing medications, assistance with personal care, supervision and special programs for individuals with Alzheimer's disease, or 24-hour nursing care. The services available in each facility are often regulated by the state in which the facility operates (for example, some states do not allow some types of facilities to include residents who are wheelchair bound or who cannot exit the facility on their own in an emergency). Facility-based care is known by a wide variety of names, including board and care, assisted living, adult foster care, Continuing Care Retirement Communities (CCRCs), and nursing homes.
Facility-based service providers include the following:
Adult Foster Care
Adult foster care can be provided for individuals or for small groups of adults who need help functioning or who cannot live safely on their own. The foster family provides room and board, 24-hour availability, help managing medications, and assistance with Activities of Daily Living. Licensure requirements and the terminology used for this type of facility vary greatly from state to state.
Board and Care Homes
Board and care homes, also called residential care facilities or group homes, are smaller private facilities, usually with 20 or fewer residents. Most board and care homes accept six or fewer residents. Rooms may be private or residents may share rooms. Residents receive meals, personal care and have staff available 24 hours a day. Nursing and medical attention are usually not provided on the premises. State licensure and the terminology used for this type of facility vary greatly.
Assisted Living
Assisted living is designed for people who want to live in a community setting and who need or expect to need help functioning, but who do not need as much care as they would receive at a nursing home. Some assisted living facilities are quite small – with as few as 25 residents – while some can accommodate 120 or more units. Residents often live in their own apartments or rooms, but enjoy the support services that a community setting makes possible, such as:
·up to three meals a day;
·assistance with personal care;
·help with medications, housekeeping, and laundry;
·24-hour security and onsite staff for emergencies; and
·social programs.
The cost of assisted living varies widely, depending in part upon the services needed by the resident and the amenities provided by the facility. Assisted living is regulated in all states, however, the requirements vary.
Continuing Care Retirement Communities (CCRCs)
Continuing Care Retirement Communities (CCRCs) are also called life care communities. They offer several levels of care in one location. For example, many offer independent housing for people who need little or no care, but also have assisted living housing and a nursing facility, all on one campus, for those who need greater levels of care or supervision. In a Continuing Care Retirement Community, if you become unable to live independently, you can move to the assisted living area, or sometimes you can receive home care in your independent living unit. If necessary, you can enter the onsite or affiliated nursing home. The fee arrangements for CCRCs vary by the type of community. In addition to a monthly fee, many CCRCs also charge a one-time “entrance fee” that may be partially or completely refundable (often on the sale of the unit).
Nursing Homes
Nursing homes, also called Skilled Nursing Facilities (SNF) or convalescent care facilities, provide a wide range of services, including nursing care, 24-hour supervision, assistance with Activities of Daily Living, and rehabilitation services such as physical, occupational, and speech therapy. Some people need nursing home services for a short period of time for recovery or rehabilitation after a serious illness or operation, while others need longer stays because of chronic physical, health or cognitive conditions that require constant care or supervision.
Home and community-based services (HCBS) describe a range of personal, support, and health services provided to individuals in their homes or communities to help them stay at home and live as independently as possible. Most people who receive long-term care at home generally require additional help either from family or friends to supplement services from paid providers. This is because so much of the care needed is personal care: help with activities such as bathing and dressing, help managing medications, or supervision for someone with a condition such as Alzheimer's disease.
Some of the most common home and community services are:
Adult Day Service (ADS) Programs
Designed to meet the needs of adults with cognitive or functional impairments, as well as adults needing social interaction and a place to go when their family caregivers are at work. They provide a variety of health, social, and other support services in a protective setting during part of the day. Adult day centers typically operate programs during normal business hours five days a week; some have evening and weekend hours. These programs do not provide 24-hour care.
Case managers/geriatric care managers
Health care professionals (typically nurses or social workers) who specialize in assisting you and your family with your long-term care needs. This includes, but is not limited to assisting, coordinating, and managing long-term care services; developing a plan of care; and monitoring your long-term care needs over extended periods of time.
Emergency response systems
Which provide an automatic response to a medical or other emergency via electronic monitors. If you live alone, you wear a signaling device that you activate when you need assistance.
Friendly visitor/companion services
Which are typically staffed by volunteers who regularly pay short visits (under two hours) to someone who is frail or living alone.
Two different services, which may be provided by a single agency or separate agencies. Home health care typically includes skilled, short-term services such as nursing, physical or other therapies ordered by a physician for a specific condition. Home care services are most often limited to personal care services such as bathing and dressing, and often also include homemaker services such as help with meal preparation or household chores.
Homemaker/chore services
Can help you with general household activities such as meal preparation, routine household care, and heavy household chores such as washing floors, windows or shoveling snow.
Meals programs
Which include both home-delivered meals (so called “Meals-on-Wheels”) or congregate meals, which are provided in a variety of community settings.
Respite Care
Which gives families temporary relief from the responsibility of caring for family members who are unable to care for themselves. Respite care is provided in a variety of settings including in the home, at an adult day center, or in a nursing home.
Senior Centers
Which provide a variety of services including nutrition, recreation, social and educational services, and comprehensive information and referral to help people find the care and services they might need; and
Transportation services
These can help you get to and from medical appointments, shopping centers and access a variety of community services and resources.
A caregiver is a family member, partner, friend, or neighbor who helps care for an elderly individual or person with a disability who lives at home. In 2004, there were more than 44 million caregivers age 18 or older in the United States - about 21% of the adult population – providing care for an adult family member or friend. Approximately 60% of caregivers are women. Thirteen percent (13%) of caregivers caring for older adults are themselves aged 65 or over. The typical caregiver is a 46-year-old woman who is married and employed, and is caring for her widowed mother who does not live with her.
Caregivers provide a vast array of emotional, financial, nursing, social, homemaking, and other services on a daily or intermittent basis. A 2006 study of caregivers found that on average caregivers spend 21 hours a week giving care. Half of them have intensive caregiving responsibilities, performing at least one activity of daily living, such as bathing and feeding, for their care recipients. Twenty-six percent (26%) perform three or more of these activities. Eighty percent (80%) of caregivers perform activities like fixing meals, doing housework, and providing transportation to medical appointments.
There are many reasons why people don't plan ahead for long-term care. These include the natural tendency to avoid thinking about becoming dependent on others for your care, misinformation about the risks of needing care, and lack of knowledge about the cost of care and payment options.
Most people don't like to think about getting older, developing a disability, becoming less independent, or needing help with personal care. Many people don't realize that their chance of needing long-term care by the time they turn 65 is as high as 70 percent.
People commonly misunderstand how expensive long-term care is, and how it is paid for. Consumer surveys have shown that many individuals don't realize that health insurance, Medicare, and/or disability coverage do not pay for most long-term care services. Medicaid pays for some long-term care services, but only if you qualify for the program because you have limited income and financial resources.
Some people find it too difficult to raise these subjects with their loved ones, making it difficult to explore and define their plans. Adult children often feel like they are patronizing their parents if they raise the subject or they are afraid of giving the impression that they might not want to provide care if it is needed. Parents often don't want to make adult children uncomfortable or to discuss details of their finances with them.
Finally, some people realize it is important to plan, but don't know how to go about it. The best way to begin is with small and easy steps. Even just talking with your loved ones is a great first-step!
Planning ahead for long-term care is important because there is a good chance you will need some long-term care services if you live beyond the age of 65. About 70 percent of people over age 65 require some services, and the likelihood of needing care increases as you age.
Planning ahead helps you understand what service options are available in your community, what special conditions may apply for receiving services, for example, age or other eligibility criteria, what services cost, and what payment options – public and private – apply. Having this information helps ensure you will have a range of options when you need long-term care, and makes it more likely that you will have more choice and control over where and how you receive services.
Planning ahead is important because the cost of long-term care services often exceeds what the average person can pay from income and other resources. By planning ahead, you may be able to save your assets and income for uses other than long-term care, including preserving the quality of life for your spouse or other loved ones. With planning, there is a greater likelihood of being able to leave an estate to your heirs, because you are less likely to use up your financial resources paying for care.
Planning ahead also means less emotional and financial stress on you and your family. It can provide a way to involve your family in decisions without depending on them to bear the entire burden alone.
Finally, for many people, one of the most important advantages of planning ahead is to ensure greater independence should you need care. Your choices for receiving care outside of a facility and being able to stay at home or receive services in the community for as long as possible are greater if you have planned ahead.
