Long Term Care Planning

Long-term care planning checklist

Long-term care planning checklist

In this article

— Last Updated May 27, 2022

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24 mins
Reviewed by
Eric Berkman

Guide Long-term care planning checklist

— Last Updated May 27, 2022

Stephanie Wilson

Director of Operations

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Reviewed by

Eric Berkman

Even though planning your future is impossible, making some plans for long-term care is crucial. Pre-planning for long-term care is unique. During your aging process, you never know what to expect. There is a sense of impossibility when you do not need something right now.

As we age, we almost always need some assistance. The reality is that more than 800,000 people are living in assisted living facilities in the United States, and this number is expected to increase as people age. Approximately 70 percent of people 65 and older will need long-term care at some point in their lives. The best way to avoid being caught off guard at a vulnerable time in your life is to be prepared.

Making a decision will be much easier if you are familiar with your options and the costs associated with those options. How do you get started? Using this long-term care checklist, you can financially plan for your long-term care needs and ensure nothing is overlooked.

What is long-term care planning?

Long-term care is a broad range of services essential to those affected by incapacitating illnesses or impairments. Treatments like these differ significantly from standard health care, such as doctor visits and medications. Long-term care insurance, on the other hand, covers custodial care, which includes help with eating, drinking, and using the bathroom.

This type of assistance is more likely to be needed by older people, but everyone may need it at some point. In these situations, long-term care may be an option if the individual or family member can no longer care for themselves adequately.

Setting aside money for long-term care costs or taking out insurance to cover risks is not enough to establish a long-term care plan. The long-term care plan must consider how the individual wants to receive care, the kind of care they wish to receive, who will provide the care if they’re going to include family members in the process, and how they will pay for the treatment.

There is a common misconception that long-term care insurance is the only component of a long-term care strategy. As a result, many people who conclude that standard insurance products are unsuitable for their needs skip further preparation and miss out on many other planning opportunities and benefits.

How should a Long-term care plan be developed?

There are several potential issues to consider when developing a long-term care plan, including:

  • The state of your health: Aside from your current health status, you should also consider any potential illnesses. This information will allow you to determine what kind of long-term care you might require and how much it might cost.
  • Housing arrangements: If you need to move into an assisted living facility or nursing home as you age, consider your current living arrangements.
  • Financial information: It is essential to consider how you will pay for long-term care. Among the options for paying for long-term care are researching insurance and government benefits.
  • Legal information: Your long-term care plan should consider the legal requirements and restrictions surrounding long-term care, such as Medicaid eligibility rules.
  • Caregiver information and support: When it comes to family dynamics, it is essential to consider your children’s or spouse’s needs as part of your long-term care plan. They should also understand and be prepared to implement any long-term care plan you have with them if necessary. Family members or professionals may provide long-term care support to those in need. Planning for this support and identifying who will provide it is essential.
  • Quality of Life: A person’s quality of life should be considered when planning long-term care. Developing a plan should consider the individual’s preferences and wishes and ensure the individual’s quality of life is preserved.

Who is it for?

Long-term care planning ensures that your or your loved one’s needs are met when you cannot care for yourself. Getting older makes it more important to have a practical plan. The fact that many people are self-sufficient well into their retirement years does not mean they should not prepare for the inevitable. Several factors need to be considered when creating a long-term care plan.

Deciding on a caregiver

To build your plan, you must determine how and where you would prefer to receive care, as these decisions affect your healthcare costs. It would be best to discuss your long-term care plans with your loved ones to reach an acceptable agreement.

To get you started, here are a few questions:

  • How will your care be provided? Will your family members look after you or be cared for in long-term care facilities?
  • Are my family members likely to provide my care (as a caregiver), or will they supervise the care I receive?
  • Would caregiving impact your family members if that were to happen?
  • What type of care would you like to receive, and where would you like to receive it?
  • Who will cover your cost of care?

The role of a family caregiver

Home healthcare is more common than long-term care facilities. The responsibility of being a caregiver falls heavily on the shoulders of family members, and as a result, they are typically underpaid, untrained, and overworked. Planning for long-term care should take caregiving needs into account.

In most cases, you will need long-term care for the rest of your life. Ultimately, the goal is to improve the quality of life for you or a loved one. Individuals can remain independent in their homes while receiving home care, allowing them to live as comfortably as possible.

Caregiving for the elderly often involves medical assistance, and a routine task such as checking blood pressure can fall under this category. Understanding the role a family caregiver plays will help you understand if 

A thorough understanding of medical requirements

One of family caregiving roles is to ensure they thoroughly understand your loved one’s medical needs. This includes staying in touch with their doctors and other medical professionals. It will be one of your most significant priorities to ensure that you or your loved one has the right medication at the right time and to be aware of all their conditions and how to treat them effectively.

Assisting with transportation

Taking care of transportation needs like grocery shopping, ensuring you get to doctor appointments, and running errands will likely fall to your caregiver.

The management of finances

Seniors who require family care may find managing finances overwhelming. A budget and proper financial management will prevent accounts from going unpaid or overspending. When you no longer have the capacity to look after your finances, your family caregiver will need a durable power of attorney.

Supporting emotional well-being

Loneliness is often not diagnosed like depression or other mental health disorders. Loneliness has many negative effects on seniors’ health, including depression, cognitive decline, and physical decline.

Health Resources and Services Administration research has shown that loneliness increases the risk of serious health conditions such as dementia (by 50 percent), stroke (by 32 percent), heart disease (by 29 percent), mental health disorders (by 26 percent), and premature death (by 26 percent).

Providing comfort, conversation, and companionship to loved ones as a family caregiver is part of the caregiver’s role.

Safety at home

The safety of seniors living alone is one of the most important considerations. Modifying your for when you age in place is essential. Family caregivers can enjoy greater peace of mind with a security system. To ensure their safety, install smoke detectors, handrails, sensor bathroom lights, and an emergency remote in case they need help immediately.

The impact on family caregiving

Family caregivers are significantly impacted by long-term care for loved ones. Caregiving can be a full-time job with no days off, vacations, or sick days. There is a possibility that a family caregiver can become a full-time occupation. As caregivers scramble to ensure the loved one is properly cared for, physical, mental, and emotional health concerns are often overlooked.

Family members often become caregivers due to a lack of preparation. It is only possible to provide care for a family member if they have made the decision and understand their caregiver role.

Making long-term care planning work for individuals and families

There are a few key steps involved in creating an effective long-term care plan:

  • Identify the type of care that may be needed and its potential costs.
  • Explore your options for long-term care, including in-home care, assisted living, and nursing homes.
  • Examine different funding options for long-term care, such as private pay, Medicaid, and long-term care insurance.
  • Discuss long-term care plans with family members and loved ones and find out how they can help.
  • To ensure that all legal and financial considerations are considered, consult an elder law attorney, financial advisor, and senior care manager.
  • Consider factors such as location, cultural background, and level of care needed when creating a customized plan.
  • Maintaining a long-term care plan meets the individual’s needs and changes as required.

Advanced long-term care planning

Health issues and end-of-life wishes are thorny topics but deserve to be discussed. When planning for long-term care, difficult decisions must be made ahead of time. Long-term care planning involves selecting family members you can trust to provide legal and medical care and make important financial decisions.

Here are some essential details you should know during times of vulnerability when you cannot take care of yourself.

1. Advanced directives

If you become incapacitated, advance directives specify how your medical decisions should be made. This is also known as a durable power of attorney. Your plan can specify what kind of care and medical measures you want if you’re near death, such as breathing machines or dialysis. Without these arrangements, your loved ones may not understand your wishes.

Choosing an advance directive will not limit your freedom of choice, and it will only be effective if you cannot speak for yourself. You can choose three types of advance directives: a living will, health care directives, and advance care planning documents.

2. Living wills

In the event of a terminal illness, permanent disability, or incapacity to make informed decisions regarding emergency care, having a living will give medical professionals access to your wishes. Using a living will, you can specify what medical treatments you would like and would not want and the circumstances under which your decisions would be valid.

3. Health care directives

In a health care directive or durable power of attorney for health care, someone is named to make medical decisions on your behalf when you cannot. You should ensure that your proxy knows your priorities and objectives, even if they are called representatives, surrogates, or agents.

In other words, they will be able to make treatment decisions just as you would. Living wills can be selected as a replacement or addition to power of attorney. With your designated healthcare proxy, you will have peace of mind should anything happen to you.

4. Advanced Care Directives

If your advance directive doesn’t cover a specific medical condition, you may want to create documents expressing your final wishes. If your doctor advises you that such medical interventions may not be sufficient given your current health, the importance of this becomes even more apparent.

It is unnecessary to have an advance directive, or a living will obtain a do not resuscitate or do not intubate order. It would help to inform your doctor about your preferences for establishing DNR or DNI orders. Upon receiving the orders, your doctor will enter them into your medical record.

It is suggested that you establish a DNR or DNI order whenever you enter a new hospital or healthcare facility, regardless of whether you have an existing living will that addresses your resuscitation and intubation preferences.

Long-term care plan legal documents

Long-term care arrangements require the preparation of numerous documents. It is a good idea to clarify your wishes by having these items collected and accounted for in advance.

Personal records

  • Your legal name in full
  • Your Social Security number
  • Residential address
  • Name, date, and place of birth
  • The names and addresses of your spouse and kids
  • Where to find birth certificates, death certificates, marriage certificates, divorce certificates,
  • Citizenship certificates and adoption certificates
  • Phone numbers and names of relatives, doctors, lawyers, and financial advisers
  • Medications you take regularly (keep this updated)
  • Where to find your living will and other legal stuff

Power of Attorney (POA)

The durable power of attorney allows a caretaker to take charge of someone else’s affairs. Health care and financial powers of attorney need to be created separately.

HIPAA authorization to receive medical information

A caregiver can view a patient’s medical files using a HIPAA release form and communicate with their doctors regarding their condition. It enables healthcare practitioners to decline to disclose patient health information to third parties without fear of repercussions. They may require a different HIPAA release form for each doctor or healthcare facility with whom they interact.

A living/last will

To ensure that all assets are distributed equally and to reduce the possibility of family disputes, it is advisable to use a revocable living trust and a last will. Since probate laws can be complex, getting assistance when drafting a will or trust is a good idea.

End-of-life – medical directives

As mentioned before, if you cannot communicate during a medical emergency, a living will is an advanced healthcare directive that family members can carry out.

Revocable living trusts

With this document, an older person can transfer assets to their beneficiaries while still alive, preserving control over their estate. By acting as executors, the seniors effectively administer their estates. Revocable living trusts are primarily used to avoid probate when the senior passes away, which is the primary benefit.

Financial documentation

The person with power of attorney should have a copy of these common documents as well as a copy of a clear account. Ensure the following is included:

Financial Plans and Records

  • Bank accounts
  • CDs
  • IRAs
  • Retirement plans
  • Brokerage accounts
  • Credit card bills
  • Mortgages
  • Car loans
  • Home equity loans.

Income Statements

  • Social Security
  • Pensions
  • Interest yields
  • Dividends
  • Minimum distributions from IRAs
  • Any other income that is regularly received.

Insurance policies

  • Medicare supplement list
  • Medicare details
  • Long-term care insurance policies
  • Life insurance policy
  • Annuities
  • Homeowners Insurance
  • Care insurance
  • Liability insurance

Ensure you have a complete list of your health care providers and copies of health care plans. 

Long-term care facility options

Health care or personal well-being are the primary goals of long-term care facilities. Several options are designed to allow your loved one to maintain a high level of independence while receiving assistance with daily tasks such as bathing, grooming, dressing, and preparing meals. In addition to structured activities, they often provide rehabilitative, medical, and nursing care to patients.

As aging parents cannot properly care for themselves at home, adult children often become overwhelmed with caregiving duties, putting their health at risk and neglecting their own needs. There may also be the possibility that the adult child is not competent to provide all the care required daily.

Long-term care for the elderly will provide a sense of security to the older adult and the caregiver, as they know that any healthcare needs will be met in the future. To help you plan for long-term care, let’s take a look at the various long-term care facilities.

Skilled nursing facility

Skilled nursing facilities (SNFs) offer medical care provided by trained professionals, including nurses, physical therapists, and speech therapists. There is 24-hour availability of this service. In addition to dressing, eating, and bathing residents, staff members also assist them with daily tasks.

The applicant must have a medical condition related to the hospital to be eligible for admission to a skilled nursing facility. A facility of this type typically serves people who no longer require acute care following a significant health event, such as a stroke or surgery. While a skilled nursing facility provides long-term care, it is generally used for a short period of time.

A skilled nursing facility is the most expensive type of long-term care facility, and the reason for this is the skilled medical care and scope of care involved. Genworth estimates that a semi-private room in a skilled nursing facility will cost $94,900, while a private room will cost $108,405 annually.

Nursing home care

Most people immediately think of nursing homes when they think about long-term care, and the purpose of these facilities is to provide actual long-term care, not short-term care. In addition, they offer low-level nursing and custodial care rather than intensive medical treatment.

Nursing home residents need round-the-clock care due to their physical or mental limitations. The cost of nursing homes is usually lower than that of skilled nursing facilities, and the prices aren’t affordable. Depending on the facility, a nursing home can cost between $94,896 and $108,408 per year, according to a Genworth Cost of Care Survey.

Assisted living facility

Nursing homes are the most hands-on care facilities, while assisted living facilities provide less. State regulations dictate their definitions, so they differ from state to state. Assisted living facilities are designed to provide residents with a home-like environment that fosters independence.

Among the services offered are:

  • An average of one to three meals a day is recommended
  • Keeping track of medications
  • Laundry and housekeeping
  • A variety of social and recreational activities
  • Care that is limited

Several factors determine the cost of ALFs, such as the size of the apartment or room, the services provided, and the location. Eventually, the level of care is too high for the ALF to provide, and the resident will require a nursing home as their ability to care for themselves declines. According to the Genworth survey, assisted living costs around $4,500 per month, or $54,000 per year.

Adult day care centers

In an adult day care facility, caregivers are relieved of their daily duties while ensuring their care recipients receive quality care in a safe, friendly environment. Some centers provide additional services during evenings and weekends in addition to regular business hours.

Depending on the facility, adult day care will offer various services. While some of these facilities provide health services and social and recreational activities, others offer comprehensive medical care by a registered nurse or another healthcare professional. There are also services for adults with dementia and other health conditions.

There may be differences in the features offered by different facilities, but all of them provide these services in some form. Some of the services you can expect to receive are:

  • Assisting with eating, taking medicine, toileting, and walking
  • Providing counseling services
  • Mental stimulation or educational programs
  • Programs for physical activity
  • Basic healthcare services
  • Snacking and meal preparation
  • Engagement in social activities
  • A variety of therapies
  • Services related to transport

Caregiving education, care planning assistance, and counseling are also available in some facilities. It is estimated that the average cost of adult day cares for a month is $1,600, but the cost can vary significantly between facilities and locations.

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Continuing care retirement community (CCRC)

Long-term care communities with varying levels of care are called Continuing Care Retirement Communities (CCRCs). The goal is for seniors to age in place. A CCRC facilitates the continued living of seniors at any stage of aging – while also adapting to their changing needs. Seniors can live in one location for the rest of their lives, allowing them to meet all their needs without moving.

Retirement communities offer a variety of services, including:

  • Providing health care and nursing
  • A communal dining area is usually used for meals
  • Cleaning and maintenance
  • Assistance in an emergency
  • Help with personal care
  • Social and recreational activities
  • Security 24 hours a day
  • Maintaining the grounds and buildings

The CCRC is a relatively recent long-term care facility that caters to good-income older people. CCRCs usually charge entrance and maintenance fees, and the cost will depend on the facility’s medical center.

Memory care

Memory care services offer specialized care for seniors diagnosed with Alzheimer’s and other forms of dementia. As a result of cognitive aging, the care employees are specially trained to understand the needs of people at all stages of dementia and to provide support for seniors who may be experiencing difficulty communicating, frustration, anxiety, or aggression. To prevent resident wandering, one of many symptoms of dementia, memory care facilities typically take extra security measures.

These facilities provide a variety of services, including:

  • Residents can receive 24-hour care that is tailored to their individual needs.
  • Seniors can be stimulated by activities such as brain games led by trained staff.
  • Various therapies are available to enhance memory, ranging from music to art therapy and aromatherapy to sensory stimulation.
  • Providing a safe and secure environment with keypad entry for both family and employees, as well as carefully designed layouts

To meet the seniors’ needs, staff members receive special training. There is usually an increased cost associated with memory care compared to non-memory care. According to the community’s location, amenities, and pricing structure, memory care typically costs more than non-memory care.

Home care

Any professional support services that allow someone to live safely at home are considered home care. Home care services can help people with age-related disabilities, chronic health problems or medical setbacks be more independent; manage chronic health issues; recover from a medical setback; or live independently.

Home care services fall into three main categories.

Non-medical home care

Non-medical home care is about assisting with basic daily tasks such as cooking and cleaning and supporting physical and lifestyle needs. Home care can help older adults enjoy a more comfortable and safe lifestyle. Several levels of care are available for older adults, family caregivers’ preferences, and needs.

It is important to note that these caretakers aren’t medical professionals but are trained to help those who suffer from chronic illnesses, aging, or disabilities with essential daily activities. However, specialized training is available to some personal care professionals.

Providing non-medical home care can also include helping individuals move, sit, or stand for daily activities. As well as providing companionship for older adults who cannot leave their homes or need stimulation to prevent dementia, some caregivers are hired to help with household chores.

You or your loved ones can receive different types of non-medical home care daily, weekly, or monthly, based on their needs.

Home nursing care

Home nursing care aims to provide medical care to seniors with chronic or disabling conditions at home. It is also known as long-term nursing or home-based skilled nursing. A registered nurse or a licensed practical nurse provides home-based nursing care.

Depending on the needs of their patients, in-home nurses offer various services. Many basic tasks can be performed, including medication administration. Specialized services are often included, such as care for patients with injuries or help with surgical care. Essentially, a nurse can help patients create medication schedules to keep their health on track or monitor their health needs after surgery.

Nursing care can also be provided to family members so that they can help care for their elderly relatives. Families can also learn how to handle basic care procedures at home, making them more independent.

In-home nursing care may be invaluable for seniors with chronic health issues, but it isn’t necessary for all.

Home health care

As an alternative to nursing care, home health care treats patients with illnesses and injuries on a short-term basis. Medical professionals other than nurses can provide home health care, including physical therapists, occupational therapists, social workers, speech therapists, and physicians. Home health care aims to assist patients in returning to an independent lifestyle.

Home health care differs from the other two categories in that a doctor must prescribe it. A physician often orders home health care to assist a patient in recovering from a significant health event such as a stroke or heart attack. The physician and other medical team members will develop a care plan once the order has been made.

Patients will receive medical care at their homes from health professionals. A stroke patient, for example, will likely need several different therapies, from speech therapy to physical therapy to neurologist care. The most common use of home health services is to continue care after a patient has been discharged from the hospital.

If your loved one has endured a significant medical event but still requires additional care to get back to their average level of self-sufficiency, then home health care may be helpful. The service will also be beneficial if the senior cannot drive after a medical event or requires help coordinating a large medical team.

Senior rehabilitation care facilities

An integrated team of doctors, nurses, therapists, and social workers works with patients at rehabilitation care centers according to their specific needs. Each patient is given a personalized treatment plan to help them return to normal functioning as soon as possible after treatment is complete. Patients receive 24-hour supervision and treatment during residential rehab with regular progress monitoring.

Those who require rehabilitation and follow-up long-term care if they have suffered or are recovering from an ICU stay, individuals with disabilities, and ventilated patients fall into this category.

Patients with ongoing illnesses are recommended to stay in a rehabilitation hospital for immediate medical attention. The reason is that some things are beyond the scope of a home nurse, and they may need emergency care that only a trained doctor can provide.

Hospitals that offer rehabilitation also have all the equipment necessary to deal with an emergency; ventilators, appropriate medications, healthcare machines, and more can be found in rehab facilities without any problems. A nursing facility, nursing home, or private residence cannot offer everything needed for treatment under one roof.

The following services are typically provided as part of rehab care:

  • Treatments prescribed by doctors
  • Therapies such as physical therapy, occupational therapy, and speech therapy
  • Managed pain
  • Assistive services
  • Providing assistance with dressing, bathing, grooming, and eating activities of daily living (ADLs)

The treatment will also include education on safety and care at home, such as fall prevention.

Medical foster Care

VA Medical Foster Homes Program provides nursing-home-level care for veterans suffering from chronic medical conditions. It is a private residence where caregivers and relief caregivers offer 24-hour supervision and care. A trained caregiver provides support to a small number of people in these facilities, which are similar to adult family homes.

Veterans who need nursing home care but prefer a quieter setting rather than an institutional one may find it a better option than a nursing home. VA provides caregiver training to ensure that VA care is provided appropriately. Home-based primary care is offered to veterans living in a Medical Foster Home.

VA reports that veterans are responsible for the costs of care they receive at a medical foster home out of pocket, through long-term care insurance, VA Aid and Attendance benefits, or other benefits.

Hospice care

Patients nearing the end of their lives receive hospice care, including a range of health and comfort care services. These patients typically refuse medical treatment or are ineligible for curative measures such as surgery or advanced medical interventions. Their life expectancy is expected to be no more than six months after admission to hospice care. Providing increased comfort care services is the most crucial consideration in hospice delivery.

Hospice services include medication delivery, particularly measures to relieve pain, bathing assistance, activities of daily living (ADL), and spiritual counseling. Hospice services can be tailored to the specific needs of hospice patients based on the types and frequency of hospice services they require throughout their hospice admission. Most of these services are provided in the patient’s home.

Hospice care services are provided by hospice care teams that include nurses, medical professionals, therapists, volunteers, and pastors. The comfort care team deals with problems related to comfort care. These services address the medical, spiritual, and other needs of patients nearing the end of their lives.

Paying for your long-term care needs

While you are planning your retirement and long-term care needs, one of the most important considerations you need to make is how you will pay for it. Researching your options. Planning for your long-term needs requires you to understand what it costs. How can you finance your long-term care?

Long-term care insurance

The premiums for long-term care insurance (LTCI) are determined by your age and health history and are underwritten by companies like Policy Soliver. When you wait to apply for long-term care insurance, costs rise each year, which is why you should buy it between the ages of 45 and 65.

LTCI policies cover treatment options such as home health care, homemaker services, respite assurance, adult care aid, and other assisted living arrangements.

Several LTCI policies have provisions that allow them to adapt as technology changes. The result will be the ability to cover current and future care capabilities. Make sure you consider your future needs when choosing the amount of insurance to purchase. Nursing homes are more expensive than assisted living facilities, for example. Getting a customized policy at a reasonable price can be achieved by talking with an insurance agent or broker.

Hybrid Insurance

A hybrid or combination policy pays long-term care expenses while alive and becomes a life insurance policy for your beneficiaries in the event of your death. Life insurance benefits are usually expressed as percentages of the long-term care benefit amount.

The cost of hybrids is usually higher than that of traditional products, but they can offer additional benefits, such as the ability to protect against future premium increases. Depending on the hybrid policy, your loved ones can still receive their death benefits even if all the long-term care proceeds have been exhausted.

Life insurance with a long-term care rider

You can also purchase long-term care and life insurance benefits to pay for long-term care expenses. As an alternative to buying separate life insurance, this may be a more cost-effective solution.

When a long-term care rider is added to a life insurance policy, the insured can use all, some, or none of the life insurance benefit towards paying for long-term care costs while they’re still alive. As long as the life insurance policy remains in force, beneficiaries receive benefits not used for long-term care expenses.

A life insurance policy with a long-term care rider provides assistance with two of the six basic daily activities when the insured needs it. Understanding the eligibility requirements for long-term care benefits is critical when considering a solution.

Social Security and pension fund

Nursing home care is not entirely covered by your Social Security check, although a portion may be covered. Social Security and Supplemental Security Income will not entirely cover the care cost. The Supplemental Security Income program may also be able to qualify individuals for Medicaid.

In some instances, Medicaid can cover nursing home care, but there are essential things to remember if you intend to use this program. Social Security payments can partially offset the cost of nursing home care, but these payments cannot cover the entire cost. Medicaid can also help you pay for nursing home care if you’re 65 or older and receive Supplemental Security Income.

Medicaid

The Medicaid program is considered to be a public assistance program. Those who qualify must meet strict income and asset requirements, and low-income and asset individuals who incur high medical bills can receive Medicaid coverage for health care services.

Federal and state governments jointly fund Medicaid. Approximately half of Medicaid funding is provided by each state independently, and the remaining half is supplied by federal funds, which they distribute. Medicaid programs administered by states must comply with federal guidelines, or they will be denied federal funds.

Long-term Medicaid coverage

Aside from covering ongoing and emergent medical care, such as doctor visits and hospital costs, Medicaid pays for the following long-term care services:

  • All eligible individuals aged 21 and older can receive long-term care in nursing homes, including custodial care.
  • Nurses visit and assist with personal care at home to provide long-term care.
  • Support with laundry and cleaning, case management, and personal care at home and in the community

Personal care and other service needs are typically considered when determining eligibility for long-term care services. There may also be assistance available that can allow you to receive in-home care and/or community-based services if you need a level of assistance that indicates you need to go into a nursing home. Your state’s Medical Assistance office will provide information on specific eligibility for Medical Assistance.

How does Medicaid cover long-term nursing home care?

A Medicaid-certified nursing home provides specific medically indicated services, including:

  • Medical care and nursing services
  • Injuries/disabilities/illnesses rehabilitation
  • A mental or physical condition that requires long-term health care

Only nursing homes that are licensed and certified as Medicaid Nursing Facilities (NF) are covered by Medicaid for Nursing Facility Services. In addition, the program is only available to Medicaid-eligible individuals with no other payment method.

Medicare

Medicare does not cover most long-term care services and usually does not pay for custodial or personal care, except in exceptional circumstances. Nursing home care is generally classified as custodial care, which means that skilled medical services are not provided.

  • Medicare covers skilled nursing facilities (SNFs) for short-term stays if the following conditions are met:
  • Having been admitted to the hospital and stayed inpatient for more than three days,
    You were admitted to a Medicare-certified nursing facility within 30 days of your inpatient hospital stay.
  • A nursing facility has previously provided you with skilled nursing services, physical therapy, or other therapies or skilled care.

During each benefit period for a limited number of days, Medicare will cover a portion of the costs if you meet the above conditions.

Veterans Affairs

Veterans and their surviving spouses can receive monetary benefits through the veteran benefits program. The VA pays for long-term care for veterans with service-related disabilities and certain eligible veterans and for nursing homes and at-home care for veterans who need long-term care. It is possible for the Veterans Health Administration to cover part or all of your long-term care costs if you qualify.

Veterans who cannot pay for necessary care but do not have service-related disabilities can also receive VA benefits. The veteran may be required to pay copays based on their income.

Veterans can also receive at-home care through the VA’s following programs:

  • Survivors of veterans with disabilities and their surviving spouses are entitled to VA Aid and Attendance benefits as well as Housebound allowances, which provide them with cash to purchase long-term care services at home and in the community, including caregiver support and personal care. Veteran pension benefits are supplemented with cash.
  • In partnership with the VA, the Veteran Directed Care Program provides veterans with a flexible budget to purchase services and counseling.

PACE (Program of All-Inclusive Care for the Elderly)

PACE (Program of All-Inclusive Care for the Elderly) is a long-term care and financing program that provides all-inclusive health care for seniors who require long-term care but wish to remain in their homes. Persons eligible for PACE must be 55 years or older, be certified by the state as nursing home-eligible, and live within the program’s geographical coverage area.

This program is staffed by physicians, nurse practitioners, therapists, social workers, nutritionists, and drivers. Generally, the services are available daily at an adult day health center, and transportation is provided to the center as part of the program. While some services cannot be provided in the home, a few can.

Among the services provided through PACE are as follows:

  • Hospital and Long-term care.
  • Medical and dental care
  • Adult day care, health
  • Personal care at home
  • Prescription medication
  • Social services,
  • Rehabilitation,
  • Meals
  • Nutritional counseling

It is important to note that team must determine which Medicare and Medicaid covered services will be included within the PACE service package and any other services necessary to meet the participant’s needs. There may be a monthly fee associated with PACE.

Reverse Mortgage

A reverse mortgage or traditional home equity loan may help you pay for long-term care if you own your home. Alternatively, you may decide to sell or rent out the property.

Your home’s equity can be used to obtain a reverse mortgage. Loan payments are made after the borrower vacates the home. You must be 62 years old or older to qualify for a reverse mortgage. The money can be received as a monthly payment, as a variable credit line, or as a lump sum. Loans without income or credit history are different from traditional mortgages.

You can use the money from a reverse mortgage to pay for in-home care or finance the repair of your house to make it safer and easier to live in. Reverse mortgages, however, are not free and often come with higher interest rates and closing costs. Home equity decreases as your loan balance increases, and reverse mortgage costs vary depending on the type of loan and lender you choose.

A reverse mortgage won’t affect your Medicare benefits, but Medicaid and Social Security income eligibility may be affected.

If you spend the money within a month of receiving it, reverse mortgage payments aren’t counted as income. The unspent balance of a lump-sum reverse mortgage loan may exceed Medicaid and Social Security Income asset limits.

It is common for reverse mortgages to charge higher interest rates than other home loans due to the complexity of their products. Comparison shop as many lenders as possible to compare terms, fees, and options. Before speaking with a counselor or lender, try to learn as much as possible.

Asset-based long-term care

Long-term care can be financed by combining life insurance and annuities with assets. Regardless of whether there are claims, both products focus on long-term care as the primary benefit, with life insurance or annuity as a secondary benefit. Long-term care coverage can be considered if there is a concern that long-term care will never be needed.

A single premium can be paid or an ongoing contribution can be made. Tax advantages will be given to the premiums paid for asset-based long-term care policies, similar to traditional long-term care policies. Unlike traditional long-term care policies, underwriting may be simplified for asset-based long-term care policies.

The benefits of creating a long-term care plan

There is a common misconception that long-term care planning means buying long-term care insurance, which is just one component of a comprehensive care plan. It is important to plan for long-term care because there are many moving parts:

Providing you with more options.

The more you plan ahead, the more choices you have. The more time you have to research your options and carefully compare them, the better you can make informed decisions. You will need to make decisions when planning for long-term care, including:

  • The decision of where to live in the future, whether in your current home or in a different location that meets your changing needs
  • Preventing future health problems by making medical decisions now and taking care of yourself
  • Assessing long-term care costs, including assisted living, transportation, and more, and exploring payment options
  • Making sure legal documents protect your medical and financial decisions

To effectively address each of these items, you must give them much thought. You’ll reap the rewards if you give yourself plenty of time.

Financial savings.

There is no way around the fact that long-term care is expensive. The best way to minimize the financial burden is to plan ahead for how to pay for care, so you don’t overpay or miss out on benefits that may be available. It is important to plan ahead so you can use your savings and investments most cost-effectively. You can also search for government and community programs available to you or your family.

Providing peace of mind.

You and your family can enjoy peace of mind by planning for long-term care. If and when the time comes to implement your plan, having all your options laid out and understanding your wishes will mean that there will be very few questions. Neither your family nor your friends will be responsible for making your decisions.

By entrusting us with your care, they can relax, knowing that your needs will be met. Moreover, you can feel confident that you have made the best decision for yourself and your family, knowing that your wishes will be honored – and that your wishes will be carried out.

 FAQS

What is long-term care also known as?

Long-term care can also be referred to as personal and custodial care. Not all long-term care is formal (you must pay for it). It is not uncommon for unskilled caregivers to be supervised by trained medical personnel, such as registered nurses.

How long does the average person stay in long-term care?

There has been a two-year national average in the past. Nationally, the average is closer to one year now. The length of time someone spends in assisted living depends on various factors.

What is the best age to get long-term care insurance?

When people reach their 80s, most LTC claims begin. It is, therefore, most cost-effective to buy long-term care insurance between the ages of 50 and 65. Younger people tend to pay less for insurance, but if they purchase too early, they may be forced to pay premiums for a more extended time.

Final Thoughts

Retirement income planning should include long-term care planning, which is often overlooked. It is almost impossible for anyone to imagine losing their independence in the future. However, it is crucial to understand that long-term care can have devastating financial and emotional consequences for family caregivers. Planning for the future has never been more critical as long-term care costs rise and new illnesses emerge.

Stephanie Wilson

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February 12, 2023

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