Plan for Long Term Care Before You Need It

By Rose Mary Zapor, Esq.

Lakewood Legal Center

303-866-0990

 Long Term Care refers to a wide-range of medical, personal and social services for individuals who are unable to provide for their own needs for an extended period of time. This need for care from others may be caused by age, accident, illness, dementia, stroke, depression or frailty.

Long Term Care Planning, on the other hand, is the process of preparing for and funding long term care.

Personal needs may include assistance with activities of daily living to help move about, dress, bathe, eat, maintain hygiene, toilet, or help with incidental daily living activities like household cleaning, meal preparation, shopping, paying bills, visiting the doctor, and taking medications. In other cases, long-term care may consist of providing supervision to avoid injury or wandering, companionship, or support and respite for a caregiver.

How Expensive Can Long Term Care be?

Long term care costs can be substantial. US median rates for nursing homes are close to $210/day, while assisted living median rates hover around $115/day. The average hourly cost of home care is $20. genworth.com/costofcare

Informal Caregiving, provided by family and friends, can carry significant costs as well. These costs are almost entirely shouldered by the child(ren) of the aging parent. For more on this, see “Caring for a Loved One at Home Can Be Challenging.”

Long Term Care Can Be the Greatest Crisis Seniors Will Face

Unfortunately, there is an abysmal lack of planning for long term care in our country. A survey, conducted by the John Hancock Insurance Company, reveals most seniors acknowledge the need for planning but very few actually make preparations for long term care. The study found over 50 percent of the respondents worry about paying for long term care but almost 70 percent of respondents said they had done little to no planning for their long term care needs.

All gaining individuals, regardless of current health, should have a plan in place. Long term care can be the greatest crisis an older person faces. With the need for care, the aged lose their grasp on the three most important lifestyle concerns of the elderly;

• Remaining independent
• Having enough money
• Maintaining good health

All of this can disappear with the need for long term care. The costs of care can wipe out a lifetime of savings and destroy equity in a home and poor care planning can lead the elderly into serious withdrawal and sadness.

Here is a brief outline of ways to create a long-term care plan:

Prepare General Planning Documents and Instructions for Decision Making

These documents and instructions might include requests pertaining to care preferences, wishes pertaining to end-of-life scenarios, wants concerning preferred medical treatments, a list of health care providers, desires for disposition of property and instructions to a potential care advocate or representative. These documents and instructions can be formalized into legal documents by an elder law attorney.

Determining a Care Advocate in Advance

A Care Advocate or Personal Care Representative will represent the interests of a loved one receiving or preparing to receive long term care. This care advocate plays an important role in making caregiving decisions, arranging funding for services, and coordinating care. This person could also be given responsibility by power of attorney or guardianship. A care advocate could be a spouse or child, a caregiver, a friend, a trusted adviser, or even a certified care manager.

Planning for End-Of-Life

End-of-life planning can include preplanning a funeral and burial, preplanning final arrangements, expressing wishes for a place to die, and giving information and instructions for advanced planning documents. We recommend using a Funeral Pre-Planning Advisor to assist in these matters.

Preparing Legal Documents and End-Of-Life Arrangements

These items might include estate planning documents, advanced directives, wills, trusts, and various powers of attorney. We recommend using an elder-law attorney or an estate planner to assist in these matters.

Providing Financial Information for Future Care Costs

This planning would provide the family with a list of assets, income, a savings plan, and insurance plans. Particular funding strategies for long-term care services and asset preservation can also be discussed and planned for. This might include Medicaid or Veterans Benefits.

Make Your Wishes Known

This final step is important. No plan has meaning unless those who will be involved in making the decisions are aware of it. We encourage you to provide copies of the long term care plan to all that may be involved, even if the involvement may seem inconsequential. These directions will allow the family, caregiver and possibly the care advocate to make informed decisions based on the wishes and instructions made in the plan. This will save these individuals a great deal of time, heartache, stress and money as they implement the care plan.

GOP to protect pre-existing conditions?

http://thehill.com/policy/healthcare/316416-gop-chairman-to-introduce-bill-to-insure-people-with-pre-existing

There are many bills that are in the process of introduction in the House of Representatives to repeal and replace the Affordable Care Act, also known as Obamacare.  Many of us are anxious about the future of the program and how it will affect our Seniors and the disabled community.  Many of the bills propose the repeal of the ACA without any replacement, which would leave approximately 20 million Americans without health insurance. 

The main sticking point for many of the Representatives and Senators seems to be the cost of insuring those with pre-existing conditions or severe illnesses. 

"A Democratic aide familiar with a version of the bill said that the measure would provide for an enrollment period during which people with pre-existing conditions could get coverage. However, the aide said under the current language, insurers could charge a client any price if they have had a period of no coverage."  The Hill

In other words, if a person is discontinued from their previous insurance for any reason, the insurance company could charge any amount to re-insure the person. "The biggest problem? Both premiums and other costs remained too high for many people with health conditions to afford. The federal program ran out of money almost a year before it was scheduled to end. Sometimes the pools got so expensive for states that they had to impose waiting lists for coverage. And often, to keep costs down, risk pools set up waiting periods before they started paying bills for the very illness that made people high risk."  Kaiser Health News.

The other problem with the proposals is that, under the ACA, the Congress was supposed to provide block grants to the states to support the Act.  Instead, of the grants, most states were provided with "loans" to support the program and less than one-half of the money that was supposed to fund the program was allocated.

"But the GOP plan also would likely make insurance more expensive for older people by proposing a broader range for premiums based on age. Current premiums can vary only three-fold based on age, which is “driving out younger and healthier patients” who can’t afford them, the GOP aide said.

Under the plan, insurance companies could not charge higher rates to people with pre-existing conditions so long as they maintain continuous coverage, whether from an employer or in a policy they purchase themselves. The new high-risk pools would be available for those who have a break in coverage, or who fail to purchase during a one-time open enrollment under the plan.

The plan would get rid of most of the coverage requirements under the Medicaid program for the poor, so states could make them more or less generous than they are currently. It would also limit funding. States could opt for either a per-person cap or a block grant to spend much as they wish."  Kaiser Health News

The plans to replace the Affordable Care Act are not affordable for our Seniors and would limit benefits for the most vulnerable in our society.  If an elderly person were to need surgery to prolong life, would they get it?  Maybe not under managed care proposals.  We have all had experience with denials of care because a clerk somewhere decided it was not reasonable or necessary.  I had to defend an ambulance to transport my 90 year old aunt to the hospital because Medicare said she could have taken a cab.

Be care what you wish for.

Rose Mary Zapor