Do You Have A Gap In Your Plan?

Hopefully you have planned and saved to have an income you can live on in retirement.  You planned to use Medicare and either a traditional supplement or a Medicare replacement plan (advantage)  to cover health care costs.  Hopefully your other available income can be used for basic living expenses, travel, and some fun.

Would an unexpected bill that comes each month in the amount of $2000 to $8000 a month be a problem for your plan?  For many people, it would.  While only 70% of us will need Long-Term Care in our homes or a facility (HHS), less than 15% have sufficiently planned for this.

Does that mean all is lost when care is needed?  Not necessarily.  There are strategies that can help most anyone deal with the costs of Long-Term Care (LTC).

The least expensive way to deal with this is to purchase LTC insurance while you are still healthy, but this topic is addressing gaps, so let’s assume you did not do that.  The government has two programs which can help, Medicare and Medicaid.

We all get Medicare at age 65, whether we retired early or are holding off until later.  Medicare is health insurance which, while it does not pay for LTC, will pay for a short recovery stay in a nursing home.  Medicare has learned that is it less expensive to have you recover from surgery in a nursing home bed than a hospital bed.

Assuming you are in the hospital as an inpatient for 3 days (two midnights), transfer to a skilled nursing home for recovery purposes, and do some type of recovery care rehab 5 days per week, Medicare can pay for that care for up to 100 days AS LONG AS YOU MAKE PROGRESS EVERY DAY.  This typically does not go past 10-12 days.

Thus Medicare is not a useful payer of LTC services, but Medicaid is.  Medicaid will pay for LTC once you can prove that you are completely impoverished (broke).  Getting to broke is not pleasant.  A single person spends down all assets to $2000 and cashes in life insurance, a married, at-home spouse can keep a house, car and some money which Medicaid will take back after death.  Thus Medicaid will pay for care but you will have nothing left to pass on.

Medicaid also pays providers much less than you or I would pay by writing checks for our care, thus getting in to where you want care can be difficult.

Now, some solutions:  There are ways to make your just a part of your money last as long as you do.  A part of your net worth can be converted into life income – taking into account your [much] shorter than average life expectancy when you require care.  If you can leave 2/3 of your estate intact to pass on, it’s generally a good thing.

You can also leave money for family through Medicaid allowed gifting.  Irrevocable burial or burial spaces trusts can be funded for children and their spouses, moving a good chunk of assets to family and will not be counted as a divestment.  Medicaid rules allow this in 49 states.

The important thing to remember is that there are solutions for most any situation that can at least help.  If you would like to learn what you can do to protect some money for spouse or family, contact www.TheLongTermCareGuy.com to learn your options.

60% of Adults Worry About Paying For Long-Term Care

A recent study claims that 60% of adults worry about how they will pay for Long-Term Care (LTC), and 10% said it was their top concern.  While two-thirds of consumers agree that most people need LTC insurance, only 16% own any.

Most people have never investigated LTC insurance and simply “think” it is too expensive.  Many insurance agents who dabble in this product feed that myth by suggesting policies that are way too large for the consumer’s needs.

When someone needs LTC services, their lifestyle changes drastically.  There may not be as many vehicles in the household when someone can no longer drive.  There will be less cruises, trips to Branson, MO, golf, boating, camping, excursions, etc. when these things become difficult.  There may even be less dining out.

Thus much of the money that was spent on fun things and travel can be redirected to help pay for needed LTC services.  Savings can also help, but not by spending the savings, but rather by using the interest those savings generate to also help pay for services needed.  Thus, only the shortfall needs to come from some other source, like LTC insurance.

It is also necessary to consider where you will be living, geographically.  LTC costs vary significantly across our nation and this must be taken into consideration.  We find that most people are pleasantly surprised that after investigating such insurance with an expert who understands how and where LTC services are delivered, and can choose among many carriers for the best fit based on your age and health, that the coverage is nowhere near as expensive as previously feared.

Let me give you an example:  Lets take a 65 year old person who is only now investigating LTC insurance.  Assuming decent health (typically blood pressure and cholesterol medications have no effect on pricing) a 65 year old could purchase over $850,000 of coverage for less than $2000 per year premium.

It matters not if this is a male of female, as not all companies charge females 50% to 75% more than males.  The coverage suggested here is a 10 year benefit of $70/day, with a 90 day deductible and includes an automatic, built in 5% compound inflation factor on the $70/day benefit that will double that benefit every 15 years.  The entire benefit is paid out for each day care is needed, even if in excess of the cost of services.  The benefit is good in any setting, home or facility.

$70 per day, plus a Social Security check will often be sufficient to cover care in your own home, adult day care, or care in an assisted living facility.  Many people do not choose to purchase a policy large enough to cover the more expensive nursing home, since less and less care is done there anymore.

If the 65 year old pays that premium for 20 years, they will have paid less than $40,000 in income tax deductible premiums.  If they need care at age 85, they can collect at a starting rate of $185/day.  Over 10 years of collecting they will receive $852,000 in benefits to use in paying for LTC.

Note that the benefit increases by 5% compounded while collecting to keep up with the increasing costs of care.  This option is vital and is included in this example.

Less than $40,000 in tax deductible premiums to get over $850,000 tax free later to pay for LTC – is that as expensive as you thought?

If you are going to investigate this, investigate with an expert in LTC financing.  At  TheLongTermCareGuy.com, we have been doing nothing but the financing of LTC for 23 years now.  Give us a call at (920) 884-3030 or (800) 219-9203 and lets discuss your situation.

Inflation and Long Term Care

I am continuously appalled to find insurance agents offering Long Term Care  (LTC) insurance products that contain no 5% automatic, built in inflation on the amount the policy will pay when care is needed.  LTC insurance is purchased while still healthy enough to obtain it, and may not be used for 30 or more years.

If I tell you what LTC may cost 30 years from now, you may not believe me, so let’s go back and let history tell us about inflation.  30 years ago you could buy a new Ford Mustang coupe LX for $7189.  A first class US postage stamp was 22 cents, and a nursing home cost about $1600 a month.  You probably have some idea of what those cost today.

Most LTC workers are minimum wage employees.  The nurses and administrators are doing paperwork.  Minimum wage is going up by over 100% in several states to $15.00 per hour.  What will this do to the costs of LTC?

The New York Times published an article about a year ago saying that by 2020, more Americans would be employed as caregivers than work in retail.  What happens to wages in any industry when not enough workers apply for the jobs?  That’s right, wages go up.

I am getting bulk mail postcards in the mail, addressed to resident, from assisted living facilities asking if I will come to work, they are desperate for employees.

Now Medicare is making the problem worse.  Medicare has paid for short stays in nursing homes to finish recovering from a 3+ day stay as an inpatient in the hospital.  It is less costly to have you finish recovering in a nursing home, than in a hospital bed.  But the new system will give a capitated sum to the hospital for knee or hip replacements, and if the hospital can send you straight home, bypassing additional recovery in the nursing home, they get to keep more of the money.

Those short term stays were the only cash cow the nursing homes had.  They all employ marketing people to call on the hospitals and ask that recovering patients be sent to their facility.

The nursing homes lose money on the Medicaid reimbursements.  They made up for it by the healthy payments from Medicare for recovery care after a hospitalization.

Their cash cow is gone.

Their labor costs are increasing dramatically.

They cannot find enough workers, raising wages even more.

Americans are passing through age 65 at a rate of 10,000 every day.

Medicaid, which pays for LTC when your funds are completely exhausted down to $2000, does not have enough money to pay for all the baby boomers’ care.  Most boomers do not have enough savings to pay for their own LTC.  How do you plan to pay for the care you need when you are no longer able to take care of yourself anymore?

I bought a LTC insurance policy 15 years ago.  Initially, it would pay $4500/month for my care if needed.  It has the built in, automatic, compound 5% inflation factor on what it will pay for my care.  Today, 15 years later it will pay $9000/month for my care.  Along with my Social security and other income I can pay for my care.  I can go where I want to be cared for.  I can get the services I want and need.  Will you?

Don’t let an insurance agent who is not fully aware of the costs of LTC offer you a policy without the absolutely essential 5% automatic compound inflation benefit included.  Without this feature, it may well be a waste of money before many years have passed and costs continue to increase.

For more information, visit www.TheLongTermCareGuy.com or call us to investigate at (920) 884-3030

Discrimination

Yes, it is legal, despite what an article in the USA Today newspaper stated last week.  Long-Term Care (LTC) facilities can and do discriminate on whom they allow in.

The problem is that many people do not plan for LTC costs.  The insurance that pays for LTC is not cheap, but is actually quite reasonable compared to what it will pay out for your care when needed.  The problem is that many people will put more time and effort into finding a way to get onto Medicaid (welfare) than in finding out how they might be able to pay for their care and have choices.

Medicaid is a fall back for people who run out of money paying for their LTC.  Unfortunately, it pays less for your care than a person would pay out of pocket, or with insurance.  The facilities can actually lose money on this low reimbursement.

Is it possible to lose money on every customer, and make it up on volume?

Of course not!  Nobody, including the government will force facilities to accept a loss on every customer and go out of business.  Thus the facilities need to keep a mix of those paying for their care to offset the loss on the Medicaid recipients.

A good friend is currently trying to get her mother into a facility in the Midwest.  Most of them are asking about her mother’s finances.  If she has enough to pay for a number of years, they will accept her. If soon to be on Medicaid, they will not.  Others will accept her only if she signs that when she runs out of money and turns to Medicaid, she must leave.  How difficult will it be for her to find a facility to accept her then, when they will be losing money on her from day one?  It’s good to be charitable, but if you cannot keep your doors open, you will help nobody.

Bear in mind that with the baby boomers turning 65 at a rate of 10,000 a day, the government does not have the funds to handle all the Medicaid LTC either.  Medicaid LTC is passing both Social Security AND Medicare as a government expense that is unaffordable.

So, what is the solution to this problem?  Have you even investigated LTC insurance for yourself?  Why not?  Are you hoping that if you don’t talk about it, then perhaps you will never need care?  Really?  That superstitious?

Most people are surprised to learn that they need less of the insurance than they initially thought.  They do not take into account that when one of a couple needs care, there may be no more cruises, trips to Branson, Washington DC, the Florida Keys, etc.  No need for 2 (or 3) vehicles if only one can drive, same for the boat, camper, motorcycle.  Thus a good portion of spendable income can be redirected towards the cost of care when care is needed.

If you do not want to decimate your life’s savings, you can still use the interest they generate for care, without touching the principal.  Then, only the remainder needs to come from LTC insurance.

Many people do not purchase enough insurance to cover a nursing home, since only about 20% of care is done there.  If you can afford to cover home care and the wonderful assisted living facilities with a small policy, you have a very good chance of never seeing the inside of a nursing home.  Like your homeowners insurance, some of you do not have flood coverage, thinking the risk is too small to insure.

Lastly, the longer you wait to investigate this, the more it will cost.  Not just because you get older, but because this insurance has built in inflation to keep up with increasing care costs.  Waiting is like saving up to pay cash for your first house.  Get it now and inflation will be working for you, causing your policy to automatically get larger every year.

So, wait no more.  Give us a call at (920) 884-3030 and schedule a time to do some investigation.  You might be pleasantly surprised.  The longer you wait, the more likely something will happen, and then you cannot buy it ever again.

10 Things You Should Know Before Becoming A Parent’s Caregiver

Reprinted from Dakota Travel Nurse Home Care Blog

If you’re trying to decide whether or not to move your aging parent in with you, you aren’t alone: One out of every four caregivers lives with the elderly or disabled relative he or she cares for.* An in-your-home arrangement can have many positives. If your parent is still relatively healthy, she may be able to help around the house, contribute financially, and get to know your children in a way that could not be possible with only occasional visits. It might be easier to care for her in your own home rather than from a distance. It could be less expensive than putting her in a nursing home or an assisted living facility, but you also could pay a price in terms of necessary remodeling, time, stress, fatigue, and strained relations.

This arrangement can be great for some but not right for everyone. Before you make such a momentous decision and present that option to your parent, it is very important to take an inventory of not only of your living conditions and your support system, but of your own health and ability to take on what is likely to be a demanding role, perhaps for a very long time!

We think these 10 personal inquiries will help you begin to gain the knowledge you need to make the best decision for you, your parent and your entire family. We’ll use a mother as the example:

  1. Is your home safe and accessible for your mother, now and as she ages? If not, do you have the resources to remodel?
  2. Is your mother able to contribute financially, and are you financially prepared for the extra costs of caregiving?
  3. How do your spouse and children feel about the move-in? How well do all of you get along with your mother now?
  4. Have you discussed the lifestyle changes involved in having an elderly person in the house? Does the family agree to these changes?
  5. Will your mother be able to live by the rules of your house, support your child-rearing decisions, respect your values?
  6. What kind of care will your mother need, now and possibly in the future?
  7. Do you have the time to take this on? How much supervision and assistance can you and family members provide?
  8. Will you be able to cut back on work responsibilities during those times when you need to be home to care for your mom?
  9. Are you and your family capable of taking care of your Mom’s special needs? Do you need to hire outside/skilled help or consider assisted living?
  10. Will you be able to make time for yourself and your family? Do you know how caregiving will affect your physical and mental health? Will you be able to allow yourself to accept help and take breaks when needed?

None of these questions really take into account the physical, mental and emotional condition of your parent. Be sure to do some research on the special needs you will have to meet and cope with. For example, if your loved one has dementia and can no longer filter their behavior, will you and your family be able to cope with potentially hurtful words or actions? If your mom is diabetic and needs help checking and managing her blood sugar levels with injections, are you comfortable taking on that responsibility? Is your mom able to be left alone, and is she still able to enjoy social interaction? If so, will she be close to friends and other family members?

There are many strategies that can help with the costs of Long-Term Care, whether a parent’s or your own.  Contact TheLongTermCareGuy.com at (920) 884-3030 or (800) 219-9203 for more information.

Resources: The 10 questions above were adapted from two articles–*Moving Elderly Parents Into Your Home and 8 Questions to Ask Yourself Before Becoming Your Parent’s Caregiver. Click on the links to read more. Another helpful article is When Your Aging Parent Moves into Your Home—Deciding If You Can Do It.

If you are especially concerned about the financial aspects of becoming your parent’s caregiver, these two articles explain key factors you should consider: Aging Parents Moving In: Can you afford to have Mom or Dad move into your home? and Moving Aging Parents Into your home. How to handle renovations, taxes, and dealing with your sibs.

 

 

 

More Bad News in Long-Term Care

The numbers of seniors who need personal care help is increasing, says the CDC.  The data released last Tuesday by the CDC’s National Center For Health Statistics shows that 7.2% of seniors require help with activities of daily living in 2015, compared to 6.6% in 1997.  This includes eating, bathing, dressing and getting around as personal care needs.

Seniors over age 85 were twice as likely as adults between 75 and 84 to require personal care help, and were 5 times a s likely as adults age 65 to 74.  The report also found 6.4% of white seniors required personal care help, compared to 9.6% of black and 11.3% of Hispanic seniors.

Not only do we have more seniors, especially those over the critical age of 85, but their rate of needing care is increasing as well.  A dangerous combination!

“Nursing Home Evictions Strand The Disabled In Costly Hospitals” was a recent article by Ina Jaffe of National Public Radio.

Quote:  “What if you had to go to the hospital, and when it came time to return home, your landlord said you couldn’t move back in? Across the country, thousands of nursing home residents face that situation every year. In most cases, it’s a violation of federal regulations. But those rules are rarely enforced by the states. So, in California, some nursing home residents are suing the state, hoping to force it to take action.  …  Chicotel [a staff attorney with California Advocates for Nursing Home Reform] says the residents most likely to be refused readmission fit a particular type. First, they’re all on Medicaid, which pays nursing homes less than they get from Medicare or private insurance. Second, he says, these are patients who are behaviorally difficult to manage – for example, ‘residents with mental health issues or significantly advanced dementia, or maybe traumatic brain injury.’ They’re undesirable, says Chicotel, ‘because they might take a disproportionate amount of labor time.’”

State budgets are getting stretched thinner and thinner as seniors continue to accelerate passing through age 65.  Most of the newly 65 year olds do not need any Long-Term Care services, but as they continue to age, as you can see from the article above, the incidence of care needs is increasing.

Medicaid picks up much of the cost of Long-Term Care for those who have run through all of their savings, homes, and other assets.  Medicaid is half federal money and half state money, so everyone is sharing the pain equally.  We are now faced with only 3 workers for every retired person and the ratio continues to get worse.  Where will the money come from when you need care?

Just like responsibly planning for the time an automobile accident occurs, I have insurance for Long-Term Care as well as my auto insurance.  When I need care someday, I will simply notify my Long-Term Care insurance company.  As they receive copies of the bills for my care on a monthly basis they will send me a check each month to reimburse that cost.

I don’t have to worry if the Medicaid reimbursement rate is so low that the facility will be trying to get rid of me.  My money will come in each month, in addition to my Social Security check.  If I do not like the care I am receiving, I will find a better facility or home care agency and make changes.  When you pay for the care you want, you get the care you want.

How will you pay for your care when your health changes?  If you want to explore options, contact The Long Term Care Guy at (920) 884-3030 or (800) 219-9203.

LTC Planning, No Matter The Situation

If Long Term Care (LTC) is needed, but not planned for, there are a number of options to make the money last longer or protect some of it.  The best and least expensive way to handle this would have been to purchase LTC insurance while still healthy, preferably in your 40’s or 50’s. By the time we’ve hit 60, a fourth of us can no longer qualify to buy this insurance.

I’ll use a recent example where I was called in to a financial planner’s office as his client’s wife was about to exhaust her short duration LTC insurance policy.  The client owns a cottage in addition to a house, $200,000 of IRA money in addition to $180,000 of non IRA investments.  He owns a life insurance policy with minimal cash value and his wife has one where the cash value is only slightly less than it’s death benefit.

One of the children would like the cottage and may be able to purchase it.  Medicaid does not allow two homes, only one, and it must be sold for fair market value so as not to be a gift and disqualify her from receiving Medicaid.

His life insurance policy with a very small cash value but a significantly higher death benefit would be a shame to lose per Medicaid’s requirements.  One of their children could purchase it for fair market value (the cash value) and pay premiums to keep it in force until his death.  Hers has cash value nearly the same as the death benefit so it could be surrendered and after paying any income taxes on the gain, the remainder could be used to purchase allowed items like plot, marker, vault, casket, etc.  This would be in addition to the irrevocable burial trusts they already purchased.

In Wisconsin, the at-home spouse’s IRA accounts are not a countable asset (currently), so we can ignore those for now.  This leaves him with some at risk assets, primarily money.  If he were to fund irrevocable burial trusts for his children and their spouses now, he would only be allowed to keep half of remaining assets when Medicaid takes their “snapshot” of assets.  If he waits until wife is on Medicaid, and the spend down amount is identified, then he can fund those irrevocable trusts for children and spouses of, while keeping his entire half for himself.

A house presents a timing issue as well.  If the at home spouse decides to sell the house while spending down to Medicaid (prior to being on Medicaid), the sale price becomes an at risk asset that must be spent down.  If the at home spouse waits until the institutionalized spouse is ON Medicaid, and then sells the house, those funds can be retained by the at home spouse.

As you can see, there are things that can be done to protect assets when someone needs LTC.  Every situation is different.  Knowing what can be done and when to do it can be very helpful.  We often have family meetings to simply explain the Medicaid rules.  While we can establish the irrevocable burial trusts for you, your children and their spouses, there are no fees for doing so at The Long Term Care Guy.

For more information, visit www.TheLongTermCareGuy.com or give us a call at (920) 884-3030.

 

 

Who Are The Caregivers?

Let me start with a study done last year which said: By 2020 (now only 4 years away) there will be more people in the US working as caregivers than working in retail.

This will be true not only because everyone shops on Amazon now, but because we did not have enough children to take care of us in older age and must hire this done, at home or in a facility.  Where will all these workers come from?

Most caregiving jobs do not require a college degree.  I am getting bulk mail from facilities begging me to come work for them, all training provided, no experience needed.  Of course they are minimum wage mostly, and few offer much for health benefits, but the jobs are plentiful.  That is because we continue to pass through age 65 at the rate of 10,000 per day.  You read in many places, but we are also turning 85 in record numbers as well.

Who are the caregivers that we will hope to find available for our care when needed?  There are currently 43.5 million caregivers in the US according to the USA Today newspaper.  Their average age is 49, but 24% are between 18 and 34.  19% are over age 65, and 60% are female.  Some of them are taking time away from high paying jobs, or turning down transfer or promotions to continue the work they do for loved ones.

Caregivers help with day to day tasks that we healthy people do for ourselves.  78% of caregivers provide transportation. 76% shop for groceries.  72% do housework and cleaning.  Meal preparation is done by 61%, while 54% manage finances for another, and 31% arrange other outside services.

They help with daily activities like getting in and out of bed and chairs (43%), getting dressed (32%), getting to and from the toilet (27%), bathing and showering (26%), eating (23%), and dealing with incontinence and diapers (16%).  A whopping 57% deal with tube feedings or injections.

How well will your family or children be prepared to take over such duties?  Stress is a huge challenge for 26%, not enough time for self affects 16% and 11% find themselves financially burdened by providing care to a loved one, probably because 49% go to work late, leave early, or take time off.

It’s going to get worse. There are currently about 6.7 caregivers available for every boomer who turns 65 in 2016.  by 2031 there will be 4 and by 2045, when today’s 51 year old turns 85, there will be just 3 caregivers available for each of them.

It appears that depending on family might not work out so well.  I doubt the people who tell me they plan to die peacefully in their sleep might find that plan stymied by their health as well.  Those who say the government will provide forget the government is us, and there are too many who will need care for the healthy ones trying to hold down a job and care for us at the same time.

My Long-Term Care insurance policy is getting larger each year by 5% compounded (a built in benefit).  I will have the cash available each month to pay for whatever care I might need.  Those with the money to pay for such care will always get the best care in the nicest settings.  Have you actually thought about what your plan is?  By age 60, a fourth of us can no longer buy this insurance.  How long will you wait before investigating it?  Do you feel lucky this year?

More information is available at www.TheLongTermCareGuy.com

Long Term Care In The News

Yesterday’s Wall Street Journal had some interesting statistics on labor growth predicted for the next decade.  The article stated that 95% of new jobs would be in the service sector.

Previous articles have noted that the fastest growing service profession is caregiving.  Earlier this year the New York Times estimated that by 2020 (four years from now) there will be more people working in caregiving than work in retail.

Where are all those low wage workers going to come from? And speaking of low wages, the minimum wage is increasing, in many locales doubling to $15 per hour.  Since most Long Term Care (LTC) is minimum wage labor, what will this do to the cost of such care?

Currently $3000 a month is the base cost at many assisted living facilities, assuming you really do not need any help.  A median cost is $4500 a month and dementia often goes for $6000 a month.  Nursing homes often are $10,000 a month.  Costs have been increasing at a rate of over 5% per year (the past 8 years of recession excepted).  Now with interest rates having risen, inflation will increase, and minimum wage earners will be demanding higher wages.

How many of you can afford to pay for LTC for very long out of your current savings when your health changes?  Many people tell me they plan to die in their sleep, a noble hope, but not likely to work out for you.  Can your children leave their jobs, children, homes to come care for you?  I doubt it.

The baby boomers continue to pass through age 65 at 10,000 a day.  Some of them (like myself) have LTC insurance.  The facilities want people like me as they lose money on the low Medicaid reimbursement levels.  When there are enough people who can pay for their LTC because they purchased LTC insurance (or the few who are rich), the facilities will start declining to accept people on Medicaid.

I don’t want to think about the day when I can no longer properly care for myself either, but I know I will not become a burden on my children and will have ready access to the care I want, in a nice place I can afford.  I no longer stay at Motel 6, even if they do leave the light on for me.  I have become accustomed to nice surroundings and have little interest in changing.  If home care can work, my policy will pay for that too.

You know the day is coming, are you going to investigate what you can do for yourself, or ignore it until it happens?  You don’t need a lot of money to get LTC insurance.  Since the fall back option is to sell everything, including the house and your life insurance to go on Medicaid, you might use some of that house equity to get coverage so you can stay home if you want, to or stay in a nice place (not your children’s basement).

For more information visit www.TheLongTermCareGuy.com  You can email me questions at [email protected]

Adult Day Care is Great Respite For Caregivers, But They Are Closing Up

Adult day care is a wonderful break for family caregivers.  Family can take their loved one to a day care program where care is provided 5 days a week typically, and get a “day off” from caregiving duties.

Caregiving wears people out physically, emotionally, spiritually.  Your batteries get drained and then you cannot provide proper support for your loved one, especially if round the clock care is required.  There is a reason the airlines tell you to put on your oxygen mask before helping others, if you are worn out, you are no good to anyone else.

Thus, adult day care can provide a respite day, or possibly as many as 5 per week, giving the caregiver a chance to breathe.  It may be difficult to secure 5 days per week care, as there are generally waiting lists to get in.  This is very popular, and bear in mind that the great majority of LTC services are still provided by family caregivers.

So, why are these places closing up?  In Wisconsin, much LTC is provided by a program called Family Care. It was originally designed to use Medicaid dollars to pay for the lowest cost care available for each recipient, instead of using it for the most expensive setting, a skilled nursing facility (nursing home).

Of course, when the government pays for the more desirable assisted living facilities or care in your home, everyone wants in, upping the usage exponentially and raising rather than lowering costs.  Spreading the available dollars among more recipients also lowers the dollars available for each one.

So now the reimbursement for adult day care is so low that the adult day care facilities cannot afford to remain open.

But it only costs $45 to $80 per day to pay for adult day care out of pocket, and on a monthly basis of one day a week that is about $200 to $400 per month, surely affordable for many, you would think.

Apparently, the problem is that the families are wanting to save the available funds to use when an assisted living facility is needed.  Often times, if you do not have enough funds to pay for assisted living for at least 2 years, the facility may not accept your loved one.  This is because once the money runs out and you turn to Medicaid (of which Family Care is part of) the facilities will be losing money on the care.

A LTC facility cannot require you to leave when your funds run out (unless you agreed and signed off on this at admission).  It is also not possible to remain open for business if you lose money on every resident.  Thus the facilities often require that you have funding available for a period of time before they will admit you.  If you have no money other than Medicaid or Family Care you may end up searching far and wide for a facility that will accept you.  Will it be the place you want to spend the rest of your years?

For more information, visit www.TheLongTermCareGuy.com