Is Long-Term Care Insurance Really a Good Idea?

Forbes’ recent article entitled “Is Long-Term Care Insurance Right For You?” says that a big drawback for many, is the fact that LTCI is expensive. However, think about the costs of long-term care. For example, the current median annual cost for assisted living is $43,539, and for a private room in a nursing home, it’s more than $92,000.

Another issue is that there’s no way to accurately determine if in fact you’ll even need long-term care. Much of it depends on your own health and family history. However, planning for the possibility is key.

Remember that Medicare and other types of health insurance don’t cover most of the cost of long-term care—what are known as “activities of daily living,” like bathing, dressing, eating, using the bathroom and moving. Medicare will only pay for medically necessary skilled nursing and home care, such as giving shots and changing dressings and not assisted-living costs, like bathing and eating. Supplemental insurance policies generally don’t pay for this type of care.

Those with a low net worth might qualify for long-term care provided under Medicaid.

Shop around, because policies and prices are different. Check the policy terms and be sure you understand:

  • The things that are covered, such as skilled nursing, custodial care, and assisted living
  • If Alzheimer’s disease is covered as it’s a leading reason for needing long-term care
  • If there are any limitations on pre-existing conditions.
  • The maximum payouts
  • If the payments are adjusted for inflation
  • The lag time until benefits begin
  • How long benefits will last
  • If there’s a waiver of premium benefit, which suspends premiums when you are collecting long-term care benefits
  • If there’s a non-forfeiture benefit, which offers limited coverage even if you cancel the policy
  • If the current premiums are guaranteed in future years, or if there are limits on future increases
  • How many times rates have increased in the past 10 years
  • If you purchase a group policy through an employer, see if it is portable (if you can take it with you if you change jobs).

Typically, when you are between 50 to 65 is the most cost-effective time to buy LTCI, if you’re in good health. The younger you buy, the lower the cost. However, you will be paying premiums longer. Premiums usually increase as you get older and less healthy. There’s a possibility that you’ll be denied coverage, if your health becomes poor. Therefore, while it’s not inexpensive, buying LTCI sooner rather than later may be the best move.

Reference: Forbes (April 17, 2020) “Is Long-Term Care Insurance Right For You?”

What Should I Ask, If My Mom Is in a Quarantined Facility

Federal guidance for nursing homes state that members of the public and non-essential health care personnel and staff shouldn’t be permitted to visit (with a few exceptions, such as an end-of-life situation — as long as the visitor isn’t showing signs of a respiratory illness), according to guidelines from the Centers for Medicare & Medicaid Services.

AARP’s recent article entitled “6 Questions to Ask if Your Loved One Is in a Quarantined Facility” explains that assisted living communities are a different situation, because they’re governed by the states. As a result, there have been no broad rules covering their management during the outbreak. However, the American Health Care Association/National Center for Assisted Living, an industry trade group, is advocating that its facilities to follow the federal government’s guidance for nursing homes.

To ease the anxiety, many of these residences are making great efforts to communicate with family members, such as emails, phone calls and websites, outlining their policies and instructions for connecting with residents and posting photos of residents’ daily activities.

However, many family members are still worried about how their loved ones are doing, when they can’t confirm their well-being first-hand person. Therefore, if you have questions about their care, you need to be assertive. Be firm, polite and persistent. Here are some questions that you might ask, if your loved one is in a quarantined facility:

  1. Has anyone at the facility tested positive for COVID-19? Nursing homes and long-term care facilities have been hard hit by COVID-19, so ask about testing of all staff members, residents and any vendors who service the facility.
  2. How are you keeping the facility clean and keeping the risk of infection low for residents? Ask about the protocols put into place to protect the patients. This should include screening staff who are caring for your parents, and what are they doing to keep the place sanitized.
  3. Is the facility maintaining regular healthy-living programs? The patients need to have services, like physical therapy and occupational therapy programs designed to keep your loved one from deconditioning.
  4. How are the residents being engaged? Are there activities, like games, presentations and music to keep the residents engaged?
  5. How do I communicate with my parent? Some facilities have set up visits via Skype, WhatsApp and FaceTime between families and their loved ones.
  6. How is the facility working with drop-off deliveries? You may want to deliver something like flowers or baked goods for dad at the care facility, so find out the procedure.

Reference: AARP (April 15, 2020) “6 Questions to Ask if Your Loved One Is in a Quarantined Facility”

What are the Restrictions on Visiting the Elderly in a Care Facility?

The restrictions in Virginia started after the American Health Care Association, the largest national trade organization representing long-term care centers, and the Centers for Disease Control and Prevention issued guidance recommending extreme measures to prevent a scenario that has played out in a Washington state nursing home, where the virus spread rapidly and took many lives.

The Richmond Times-Dispatch’s recent article entitled “Virginia nursing homes restrict visitors over coronavirus fears, families worry about separation” says, however, that some family members and advocates worry that — without loved ones allowed to visit — residents will be even more vulnerable to neglect in nursing homes that already struggle to give them basic care.

“What we have found is that experts believe that this is the most prudent step that we can take to protect the residents,” said Keith Hare, CEO of the Virginia Health Care Association, the state chapter of the AHCA. “We have to put the health and well-being of these residents first. … It really is unprecedented action.”

However, some family members who are told that they can drop off supplies for the residents at the nursing home, cannot stay for a visit. Some are worried that parents with Alzheimer’s who need help eating, won’t be fed without their regular visitors because nursing homes are understaffed.

Nursing homes in the state say it was a hard decision to cease visitation, but it was necessary to prevent any exposure in the care facilities. They’re going to do whatever we can to keep it out, official say.

Innovative Healthcare Management, a company that runs five nursing homes in Virginia with a total of 750 residents, said that it has been educating its staff and preparing for a potential outbreak, since first learning of the coronavirus outbreak in China. IHM recently began screening visitors for possible coronavirus infection before they entered the facilities. The company decided to restrict all nonessential visitors, except when a resident is believed to be dying.

Nursing homes are trying other ways for family members to connect with residents, like phone calls and video chats.

While nursing homes around the country are doing the same thing and are restricting group gatherings within the centers, they are trying to make sure residents are being entertained with in-room activities, such as movies, card games, and puzzles. The focus at the facilities is on communication and keeping residents entertained.

Reference:  Richmond Times-Dispatch (March 15, 2020) “Virginia nursing homes restrict visitors over coronavirus fears, families worry about separation”

How to Plan for Nursing Home Care for Parents

The median annual cost of care in a skilled nursing facility in South Carolina is $42,000, according to a cost of care survey by long-term care insurance company Genworth. You can’t expect Medicare to cover it. Medicaid coverage doesn’t start in, until the value of your assets is reduced to $2,000, says The Columbia Regional Business Report’s recent article entitled “Nursing home care requires advance planning.”

Many people don’t know that to qualify for Medicaid, your assets have to be spent down to almost nothing. Planning for long-term care includes both insurance and financial planning. However, the long-term care insurance options are limited. There are only a few providers remaining in the industry, but it’s worth the effort to see what they have.

Long-term care insurance is a plan that lets you pay a premium in exchange for coverage for a stay in an assisted care facility, full-scale care facility, or even at home. Without a policy, those financial costs can be catastrophic.

Because the cost of long-term care is so high, begin planning for your later years as soon as possible. It’s likely that in the next few decades, when the baby boomer generation starts requiring long-term or assisted living care, paying for it could become a crisis.

For people who are starting to save for future care needs, financial planners earmark 10% to 15% of your income. If you’re older and see that you don’t have enough money saved, put away at least 20% of your income. IRS guidelines include catch-up provisions for people older than 50 for IRAs and 401(k)s.

Some group insurance plans offer long-term care options. There are some additions for life insurance policies that could extend living benefits for elder care. You should plan on paying for three years of long-term care.

How to pay for skilled care is just one of the issues a family may face in later years. You also should have a will, advance directives, medical or health care power of attorney and durable power of attorney in place to help your family with difficult decisions. Remember to make sure the beneficiaries on your insurance plans are up-to-date.

Talk to an attorney about late-life concerns.

It’s never too soon to develop some kind of plan that can ease the financial burden for you and your family.

Reference:  Columbia Regional Business Report (March 10, 2020) “Nursing home care requires advance planning

What Do We Know about Early-Onset Dementia?

Rita Benezra Obeiter, 59, is a former pediatrician who was diagnosed several years ago with early-onset dementia, a rare form of the disease. When this occurs in people under age 65, the conditions cause additional and unique issues because they are so unexpected and because most of the potentially helpful programs and services are designed for and targeted to older people.

One issue is that doctors typically don’t look for the disease in younger patients. As a result, it can be months or even years before the right diagnosis is made and proper treatment can start.

WLNY’s recent article entitled “Some Health Care Facilities Say They’re Seeing More Cases Of Early-Onset Dementia Than Ever Before” reports that her husband Robert Obeiter left his job two years ago to care for her. She attends an adult day care, and aides help at home at night.

If Dementia is a generic term for diseases characterized by a decline in memory, language, and other thinking skills required to perform everyday activities, Alzheimer’s is the most common. The National Institute of Health reports that there’s approximately 200,000 Americans in their 40s, 50s, and early 60s with early onset Alzheimer’s.

One conference discussed a rise in early dementia because of the processed foods and fertilizers or the other environmental hazards, and there are definitely some genes more associated with Alzheimer’s—more so with early onset.”

There is no clear answer, and most of the treatments help to slow down the progression.

There is some research showing the Mediterranean diet can be protective, as well as doing cognitive exercises like crossword puzzles and Sudoku.

It’s true that no one can predict the future of their health, but there are ways financially that families can prepare. It can cost $150,000 a year or more. That’s why you should think about purchasing long term care insurance starting at the age of 40.

Long-term health insurance can pay for an aide to come into your home, and it can pay for the cost of assisted living. And, remember that health insurance doesn’t cover long-term care, nor does Medicare. Plus, everyone over the age of 18 needs a healthcare power of attorney and a financial POA.

Reference: WLNY (Feb. 12, 2020) “Some Health Care Facilities Say They’re Seeing More Cases Of Early-Onset Dementia Than Ever Before”

The Need for Long-Term Care Insurance

More than 70% of seniors 65 and over will need some type of long-term care in their lifetime. This could be a few months of home health aide assistance or years in an assisted living facility or nursing home. Unfortunately, Medicare won’t pay for long-term care, which means the majority of seniors could have some very big bills.

Motley Fool’s recent article entitled “Only 16% of Older Americans Have Made This Smart Retirement Move” says that’s the reason why it’s critical to secure long-term care insurance. Your 50s are generally when it’s considered to be the best time to apply. At that point, you’re not signing up to pay premiums for too long, but you’re also more likely to get approved for a policy and get a discount on its cost based on your health. However, research from TD Ameritrade found that just 16% of Americans in their 50s have a long-term care policy.

Many seniors don’t know just how expensive long-term care is, until they actually need it. Medicare generally doesn’t cover this because its’ considered custodial care, another term for non-medical assistance. Medicare will pay for seniors to recuperate from injury or illness, but often, the need for long-term care isn’t a result of that situation.

A long-term care insurance policy isn’t cheap. Your premium costs will depend on a number of factors, such as your age at the time of your application, the state of your health and the specific amount of coverage you want.

For example, a 55-year-old man in New Jersey applying today could receive a benefit of $150 per day for up to two years. Let’s say that he ends up spending two years in an assisted living facility that costs $150 per day.

That’s going to total $109,500. Assume you also pay an annual premium of $1,195.43 for 20 years to obtain that benefit, for a total of $23,908.60. Even with the large amount of money you’ll end up paying in premiums, it’s nothing when compared to the $109,500 you might otherwise be required to shell out for your care.

It’s impossible to predict whether you’ll need long-term care, but if you’d rather not risk bankrupting your estate and yourself, look at a policy. Even though it’s ideal to apply while you’re in your 50s, you may qualify for affordable coverage in your 60s. Therefore, despite the preferred application window being closed, it may be beneficial to see what options are available to you now.

Reference:  Motley Fool (Jan. 25, 2020) “Only 16% of Older Americans Have Made This Smart Retirement Move”

When Do I Need an Elder Law Attorney?

Elder law is different from estate law, but they frequently address many of the same issues. Estate planning contemplates your finances and property to best provide for you and your family while you’re still alive but incapacitated. It also concerns itself with the estate you leave to your loved ones when you die, minimizing probate complications and potential estate tax bills. Elder law contemplates these same issues but also the scenario when you may need some form of long-term care, even your eligibility for Medicaid should you need it.

A recent article from The Balance’s asks “Do You or a Family Member Need to Hire an Elder Law Attorney?” According to the article there are a variety of options to adjust as economically and efficiently as possible to plan for all eventualities. An elder law attorney can discuss these options with you.

Medicaid is a complicated subject, and really requires the assistance of an expert. The program has rigid eligibility guidelines in the event you require long-term care. The program’s benefits are income- and asset-based. However, you can’t simply give everything away to qualify, if you think you might need this type of care in the near future. There are strategies that should be implemented because the “spend down” rules and five-year “look back” period reverts assets or money to your ownership for qualifying purposes, if you try to transfer them to others. An elder law attorney will know these rules well and can guide you.

You’ll need the help and advice of an experienced elder law attorney to assist with your future plans, if one or more of these situations apply to you:

  • You’re in a second (or later) marriage;
  • You’re recently divorced;
  • You’ve recently lost a spouse or another family member;
  • Your spouse is incapacitated and requires long-term care;
  • You own one or more businesses;
  • You have real estate in more than one state;
  • You have a disabled family member;
  • You’re disabled;
  • You have minor children or an adult “problem” child;
  • You don’t have children;
  • You’d like to give a portion of your estate to charity;
  • You have significant assets in 401(k)s and/or IRAs; or
  • You have a taxable estate for estate tax purposes.

If you have any of these situations, you should seek the help of an elder law attorney.

If you fail to do so, you’ll most likely give a sizeable percentage of your estate to the state, an ex-spouse, or the IRS.

State probate laws are very detailed as to what can and can’t be included in a will, trust, advance medical directive, or financial power of attorney. These laws control who can and can’t serve as a personal representative, trustee, health care surrogate, or attorney-in-fact under a power of attorney.

Hiring an experienced elder law attorney can help you and your family avoid simple but expensive mistakes, if you or your family attempt this on your own.

Reference: The Balance (Jan. 21, 2020) “Do You or a Family Member Need to Hire an Elder Law Attorney?”

Should I Purchase Long-Term Care Insurance?

According to Covering Katy’s recent article entitled “How to Protect Yourself From Long-term Care Cost,” to answer the question of long-term care, think about two variables: your likelihood of needing long-term care and the cost of the care.

Government statistics show that a person who’s 65 today has nearly a 70% chance of eventually needing some kind of long-term care. The average cost for a private room in a nursing home is about $100,000 per year, and a home health aide costs about $50,000 per year. When you do the math, your chances of needing long-term care are good and it’s expensive. If you needed several years of long-term care, it could seriously deplete your savings.

Since Medicare typically pays only a small part of long-term care costs, you should consider the following options for meeting these expenses:

You could “self-insure” against long-term care expenses, by setting aside some of your investment portfolio for this. However, it looks like you’d have to save a lot of money before you felt you were truly protected. This could be especially tough with the need to save and invest for the other expenses associated with retirement.

When you buy long-term care insurance, you’re moving the risk of paying for long-term care from yourself to an insurance carrier. Some LTC policies pay costs for a set number of years, while others cover you for life. Shop around for a policy that offers the combination of features you think best meet your needs. Long-term care gets more expensive as you get older. Therefore, if you’re interested in this type of coverage, don’t delay in your search.

A “hybrid” policy, like life insurance with a long-term care/chronic illness rider, combines long-term care benefits with those offered by a traditional life insurance policy. As a result, if you were to purchase a hybrid policy, and you never needed long-term care, your policy would pay a death benefit to your beneficiary. Conversely, if you ever do require long-term care, your policy will pay benefits for those expenses. The amount of money available for LTC can exceed the death benefit dramatically. There are quite a few different types of hybrid policies, so do your research before choosing a policy.

While you may decide you’re willing to take the chance of never requiring any type of long-term care, if you think that’s a risk you’d rather not take, look into all your coverage options thoroughly.

Reference: Covering Katy (Jan. 13, 2020) “How to Protect Yourself From Long-term Care Costs”

Holiday Gatherings Often Reveal Changes in Aging Family Members

A look in the refrigerator finds expired foods and an elderly relative is asking the same questions repeatedly. The same person who would never let you walk into the house with your shoes on now, is living in a mess. The children agree, Mom or Dad can’t live on their own anymore. It’s time to look into other options.

One of the biggest questions, according to the Cherokee Tribune & Ledger-News’ article is “How to pay for long-term care.”

The first question involves the types of facilities. There are many different options but the distinctions between them are often misunderstood. Assisted living facilities provide lodging, meals, assistance with eating, bathing, toileting, dressing, medication management and transportation. However, a skilled nursing facility adds more comprehensive health care services. There’s also the personal care home, which provides assisted-living type accommodations, but on a smaller scale.

The next question is how to pay for the residential care of an elderly family. This weighs heavily on the family. That elderly person is often the one who did the caregiving for so many years. The reversal of roles can also be emotionally difficult.

There are a few different ways people pay for care for an elderly family member.

Long-term care insurance, or LTC insurance. Few elderly people have the insurance to cover their residential facility stay, but some do. Ask if such a policy exists, or go through the piles of paperwork to see if there is such a policy. It will be worth the search.

Veteran’s benefits. If your loved one or their spouse served during certain times of war, is over 65 or is disabled and received an honorable discharge, he or she may be entitled to certain programs that pay for care through the Department of Veterans Affairs.

Private pay. If your loved one has financial accounts or other assets, they may need to pay the cost of their residential facility from these assets. If they don’t have assets, the family may wish to contribute to their care.

Another route is to apply for Medicaid. An elder law attorney in their state of residence will be able to help the individual and their family navigate the Medicaid application, explore if there are any options to preserving assets like the family home, and help with the necessary legal strategy and documents that need to be prepared.

Meet with an elder law estate planning attorney to learn what the steps are to help your elderly loved one enjoy their quality of life, as they move into this next phase of their life.

Reference: Cherokee Tribune & Ledger-News (November 30, 2019) “How to pay for longterm care.”

Get the Facts About Dementia Care

A person with Alzheimer’s disease or another form of dementia might need to move into a specialized care facility for his own safety and medical care. If you have a loved one in this situation, you need to know about the options available for dementia care in assisted living and nursing home facilities.

The Alzheimer’s Association created practice recommendations for nursing homes and assisted living facilities that offer dementia care for residents. These guidelines focus on six care areas:

  • Food and fluid consumption
  • Pain management
  • Social engagement
  • Wandering
  • Falls
  • Physical restraints

Care Recommendations about Food and Fluid Consumption

People with dementia do not always make good choices about the food and liquid they consume. They might not consume enough to meet their nutritional or hydration needs, or they might consume items with little nutritional value. As a result, their health and comfort can suffer.

Facilities that provide dementia care should:

  • Perform initial and routine periodic assessments of each resident’s food and fluid consumption status.
  • Develop procedures that ensure the residents consume proper food and liquids.
  • Make mealtimes enjoyable events, where staff interact with the residents and assess the food and fluid in a pleasant social setting.

Residents with physical challenges that make eating or drinking difficult should receive assessment by qualified professional specialists.

Pain Management Care Recommendations

Because many people with dementia have difficulty communicating, they under-report their pain and do not receive the treatment they need. Untreated pain is one of the main reasons why nursing home residents develop undesired behavioral symptoms and receive psychotropic drugs to manage their behavior, instead of getting relief from their pain.

Dementia care should include:

  • Including pain assessment in every vital signs check, along with pulse, temperature, blood pressure and respirations. Consider pain as the “fifth vital sign.”
  • Routinely treat pain just as one would address problems with any other vital sign.
  • Customize the pain management techniques for each resident, taking into account the individual’s risks, medical conditions, needs and other relevant circumstances.

Appropriate pain management can improve the resident’s quality of life.

Guidelines for Social Engagement

Every day, the facility should offer multiple opportunities for residents with dementia to engage in fun, meaningful social activities. The nursing home or assisted living center should consider each resident’s interests and functional abilities. A roomful of residents sitting in their wheelchairs passively watching a staff member perform an activity has little meaning for them, as compared to an event in which the residents can actively participate.

The home should respect each resident’s preferences, including a desire for solitude or downtime. The staff should never force a resident to participate in an activity.

Recommendations about Wandering

Many people with dementia engage in a behavior called wandering. Often, the resident wanders because he is physically uncomfortable, in emotional distress, is bothered by something in his environment, or is looking for social contact.

Facilities that offer dementia care need to encourage the resident to be mobile and physically active, but provide a safe and independent means for him to do so. Some dementia care facilities have hallways that loop around in a circle, so residents can satisfy the need to walk without ending up far from their rooms.

The center should assess the reasons for the individual’s wandering and try to meet those needs.  The facility should also develop protocols that prevent unsafe wandering, including exit seeking.

Guidelines to Prevent Falls

The facility should assess each resident’s risk of falling to prevent injuries. Fall injuries can rob a resident of her mobility. The center should implement measures that reduce the risk of falling. Physical restraints lead to fall injuries. For this and other reasons, nursing homes should avoid the use of physical restraints.

Recommendations on the Use of Physical Restraints

Sometimes a nursing home will use physical restraints under the misguided notion these devices keep residents safe. However, in fact, restraints often harm residents. Facilities should identify the reasons for undesired behavior and address those issues without using restraints. The staff should receive training on restraint-free techniques for keeping residents safe.

Every state has different laws, and your state’s regulations might vary from the general law of this article. You might want to talk to an elder law attorney near you.

References:

National Consumer Voice. “Dementia Care.” (accessed August 15, 2019) https://ltcombudsman.org/issues/dementia-care