Looming crisis in nursing home care

Rural and small market areas continue to experience growing “nursing home deserts,” an increasing crisis for local officials and beneficiaries facing access issues.  The problem is two-fold. The closures stem from a mix of staffing shortages and lackluster Medicaid reimbursement—with the latter causing the first. Too many people think that Long-Term Care is free from the government–and it is once you have spent everything you own down to under $2000 and cashed in your life insurance (requirements for married persons differ slightly). Then they find the “no vacancy” sign lit up at assisted living facilities, and the nursing homes closing their doors due to losing money on Medicaid residents have no room either.
It used to be “Buy LTC insurance to not go broke”, but now it’s “Buy LTC insurance so you will find a place to receive care.”

Have you thought about how you will pay for assistance when you need it?  Contact Romeo Raabe, the Long-Term Care Guy to discuss alternatives. There are solutions for almost every situation.  Call 920-362-7663 or email [email protected] .

Family Care Givers are Struggling

Family care givers are struggling and feel undervalued, according to an article published on the website The Street.  It reports on a study conducted in September 2023 by Wakefield Research and sponsored by Otuska, a pharmaceutical company. It outlines the toll that caretaking can take on family members.  To read the article, click here .

Have you thought about how you will arrange for assistance when you need it?  Contact Romeo Raabe, the Long-Term Care Guy to discuss alternatives. There are solutions for almost every situation.  Call 920-362-7663 or email [email protected] .

Will you be in the news?

Will you be in the news?
Will you be in the news?

Will you be in the news?

Many of you have read about or have seen news stories of seniors being evicted from a long-term care facility. It is a tragedy that some people spend down their savings paying for care at the end of life. Medicaid (government welfare) can help these folks, but it pays the facility far less than the cost to care for them.

You can’t lose money on every customer and make up for it in volume!

Smart people buy insurance that pays for this care.  Why not insure for end-of-life nursing care, and leave your savings to heirs?

Call TheLongTermCareGuy.com at (920) 884-3030 and learn about Long Term Care insurance.

Americans are focused on the wrong retirement risks

Center for Retirement Research at Boston College
Center for Retirement Research at Boston College

Center for Retirement Research at Boston College

A study from the Center for Retirement Research at Boston College found that Americans cite market volatility as the top retirement risk, while longevity and health care costs actually present bigger risks. The study concluded that Americans need more education about retirement risks, as well as a source of secure income and long-term care planning.  To view the article, click on the link below and then on “take me to the story”.

Research: Americans focused on wrong retirement risks

Has your planner addressed the risk of spending an extra $50,000 to $90,000 every year for 3-5 years when your health changes?  If not, or even if your planner did, remember that they specialize in investing money.  I am an expert in planning for and dealing with Long-Term Care.  Investigate with an expert and get the best advice and solutions available.  Visit my website at www.TheLongTermCareGuy.com or call (920) 884-3030 to schedule your time to investigate

Family-Provided Care Can Work–Sometimes

Family-Provided Care Can Work--Sometimes
Family-Provided Care Can Work--Sometimes

Family-Provided Care Can Work–Sometimes

The September, 2021 issue of the journal Health Affairs features a study that family-provided care (spouse or adult children) for dementia greatly diminishes the chances that the individual will need to enter a nursing home. However, full time caregiving will burn out the support team. Family simply cannot be expected to provide 24-7 care without help.

That is why I offer several home care policies that will pay for caregivers to come into the home to provide that care, while giving family members some relief. These home care policies are much less expensive and far more easily obtained – despite health problems already on record – than traditional long term care insurance policies.  However, they must still be obtained before the care becomes necessary.

You can easily burn out your loved ones with family Family-Provided Care

Don’t burn out your family or other loved ones by becoming a total burden on them.  They will surely help, but give them a break and provide a helping hand.  Investigate now, while this help is available.

Contact Romeo Raabe www.TheLongTermCareGuy.com at 920-884-3030 to investigate options.

Why Can’t I Spend my Money on Fun?

Why Can't I Spend
 my Money on Fun?
Why Can't I Spend
 my Money on Fun?

Often, retired people are afraid to spend money on fun or travel because they fear the catastrophic costs!

A recent Wall Street Journal cartoon featured a gentleman visiting his financial planner.  In the cartoon, he asks the planner, “Why can’t I spend some of my money on fun now?”

Often, retired people are afraid to spend money on fun or travel because they fear the catastrophic costs they would face if one of them needs long term care (LTC). This can be a real concern, because the U.S. Department of Health and Human Services says that 70% of people who reach age 65 will need some long-term care.  The great majority of us cannot afford it for long if we’re paying out of pocket.

Many people assume the insurance for LTC is prohibitively expensive. This is because they never investigated what the costs actually would be for them. I can tell you with near certainty that you need less of it than you imagine.  When you finally need care, your lifestyle will change considerably.  If you cannot drive there will be fewer vehicles, boats, toys, and less travel, golf, dining out, and so on.  The money spent on fun (which you SHOULD do while healthy) can be redirected towards the costs of LTC.

Most people have some savings.  Without touching the principle, you can spend the interest or yield it generates.  Add this to the savings from your lifestyle changes, and you may find you can cover a significant portion of the costs of LTC yourself.  You will only need to cover the shortfall from some other sources, like insurance, so you do not spend down all your savings and end up on Medicaid.

People investigate LTC insurance for two reasons.

  • First, they do not want to go broke.
  • Second, many long-term care service providers will not accept Medicaid.  Nursing homes generally have to because of federal laws–but a nursing home is usually the last place you want to be.  If you have the ability to pay from your cash flow and insurance, it will let you choose where and how you will be cared for. The providers will welcome you with open arms!

If you have not investigated LTC insurance, now is the time, while you are still healthy enough to get it.

It is a logical discussion and it is not appropriate for everyone.  But please investigate with someone knowledgeable in planning for LTC.  At The Long Term Care Guy, we have been doing only LTC planning for over 25 years.  Since nearly all of our business comes to us by referral, we may even may be working with your financial planner or attorney!

Call TheLongTermCareGuy.com at (920) 884-3030 or email us for a time to investigate your situation.

Why Medicaid Long Term Care is a Bad Choice

What Can I Do About Long Term Care
Most assisted living facilities don't accept Medicaid

Most assisted living facilities don’t accept Medicaid, so often Medicaid recipients needing LTC are left with only one choice—a nursing home.

Many people don’t realize that, in addition to traditional health care, Medicaid actually pays for most long-term care (LTC) in the United States.  In fact, less than 40% of Medicaid dollars are used to pay for traditional health care.  The small portion of Medicaid recipients (just over 20%) whose long-term care services are paid for by Medicaid use over 60% of the Medicaid budget dollars.

Most assisted living facilities don’t accept Medicaid, so often Medicaid recipients needing LTC are left with only one choice—a nursing home.  This is because the federal government requires nursing homes to accept Medicaid payments if they want to accept Medicare for the rehab care they provide–and this rehab care is a major source of revenue for many nursing homes.

Wouldn’t you rather receive care, when needed, at home or in an assisted living facility rather than the nursing home?  Most people would, but if you cannot afford this care – your only option might be the nursing home.

Many people mistakenly assume LTC insurance is too expensive.  It can be, if it’s not chosen appropriately.  Do you have a deductible on your car insurance or does it cover every last penny?  Mine has a deductible, so that I pay the first part and insurance pays the expensive part.

LTC is similar. Your lifestyle will change when care is needed.  You will spend less money  on vehicles if you cannot drive, and spend less on golf, travel, toys, and so on.  The money freed up by not spending it on these things needs to be taken into account in order to see how much care you can pay for. Then you only need enough insurance to cover the shortfall. If you have a nest egg, and do not want to use it all up, you can always take the interest it generates to help lower the insurance need even more—and never touching the principal.

Think you cannot get LTC insurance because of health?  I have solutions for nearly every situation – even some for people already in care.

So, you can ignore this and hope you will not be among the 70% of us who will need care – or you can investigate options to see if this concern can be handled affordably.  Your choice!

www.TheLongTermCareGuy.com  Romeo Raabe is here to help, even with just advice.

What’s it Really Like Paying for Long-Term Care

What’s it Really Like Paying for Long-Term Care?
What’s it Really Like Paying for Long-Term Care?

Annual cost range is $18,720 for adult day-care services to $100,375 for a private room in a nursing home!

As written by Michelle Singletary and published in the Washington Post on November 26, 2018

One of my favorite Spock quotes from the Star Trek television series is, “Live long and prosper.” Who doesn’t want a long life, right?

But what if the longevity means spending down your money for long-term care? And that’s if you’ve been prosperous and have the funds to pay a facility or home health aide to care for you.

Genworth Financial recently released its 2018 Annual Cost of Care survey and found that the annual median cost of care now ranges from $18,720 for adult day-care services to $100,375 for a private room in a nursing home.

I asked readers to share their long-term care experiences, and here’s what they had to say:

“My mother had Alzheimer’s and was in a memory unit for two years,” wrote Chris Gonzales from California. “My dad has been in assisted living for two and half years and for the last two years has needed round-the-clock care. The cost, when my mother was alive, totaled $230,000 a year. The cost to care for dad is now $170,000 a year. This is in Fort Smith, Ark. My brother and I are very lucky that our parents lived below their means, saved, and did extremely well investing their money in the market, so money has not been an issue. We are also grateful for the ladies that watch over our father and consider ourselves extremely lucky to have people we can depend on as we both live out of state.”

“I managed the care of my mother (who had Alzheimer’s disease) from 1998 through 2006,” wrote Debbie Trice of Sarasota, Fla. “Even that long ago, the cost of her care approached $100,000 annually once she had to move from an assisted-living facility to a skilled nursing facility. The actual cost of long-term care goes way beyond the monthly or daily facility charges. Personal expenses (e.g., adult diapers, toiletries, laundry, haircuts) can be significant. I saved some money by purchasing diapers from a wholesaler and toiletries from a discount store and doing mother’s laundry myself. Medications cost more for residents in long-term care, too. Some states require that all medication, including over-the-counter items like aspirin and vitamins, be specially packaged by a pharmacist in blister packs — at extra cost, of course. Staffing is a critical issue. To keep their rates competitive, many facilities limit their staffing levels to the minimum required by law. But then some patients’ needs can’t be adequately addressed. I found it necessary to hire private duty aides to supplement facility staff for a few hours each day.”

Lane Beckham of New Jersey wrote, “Four years ago my wife (then 71) suffered a fall which led to numerous complications over the next year. She has since been bedridden going from a home hospital bed to a wheelchair. She can feed herself, converse, watch television and read catalogues, but that’s about it. We’ve had a 24/7 home health care aide since April 2015 at a current cost of $215 a day or $78,475 a year. A long-term care policy kicks in $100 a day but only for 5 years of benefit days.”
“My mother died two years ago and for the last two years of her life, she had progressively worsening dementia,”

One reader wrote. “We (mainly my sister) arranged for her to be cared for at her home. The cost was running at about $85,000 a year and that was two years ago! Why? At times, she was simply too much for one person to handle, so we often needed two people to stay with her. And while we went with the better-rated agencies, we still had problems with sitters stealing, using drugs, having friends over and even taking my mother out when they needed to run errands. What a nightmare.”

David Treece, an investment adviser and financial planner based in Miami Shores, Fla., has a client with Alzheimer’s who has a Genworth long-term care insurance policy, which so far has paid out about $323,000.

“I have learned nothing will ruin a retirement plan faster than long-term care expenses,” Treece wrote. “Try having to come up with nearly a third of a million dollars like my client if you don’t have coverage. It’s just unimaginable for most people. My biggest concerns for my clients are a group I call ‘the alones.’ These are people who have no spouse, no children, no close siblings and really nobody else. They can’t even name a beneficiary let alone someone to serve as a power of attorney or health-care surrogate. This group seems to be increasing as so many people never had children, are divorced or never married, or are estranged from family. Who is even going to help them? Our society isn’t really set up for this, and I don’t see any easy solutions.”

*****

How comfortable do you feel paying for care out of pocket when your health changes?

  • Have you thought that Long-Term Care insurance would not be needed?
  • Do you plan on spending down to Medicaid, a welfare program and then search for a place that will accept it – and you?

If you are concerned, contact www.TheLongTermCareGuy.com at (920) 884-3030 and schedule a time to investigate with someone who understands and can help you find a way to handle this!

Who is Going to Pay for Your Funeral?

Who is Going to Pay for Your Funeral?
Who is Going to Pay for Your Funeral?

Who is Going to Pay for Your Funeral?

Asking who is going to pay for your funeral might seem like a silly question–you probably have money in savings, a vehicle, a house, even life insurance.  There should be plenty of money to pay this bill, right?

The problem is, you are gone, so now who has access to your assets?

Your Power of Attorney ends at the moment of your death.  How your assets will be distributed and who has authority will all be determined in the probate process in the next few months. So, who will come up with the funds now to pay for the funeral?  Even life insurance does not pay out for some time once claim forms are submitted.

Just recently, I received a call from a La Crosse funeral home who wanted to know how to get in touch with the Wisconsin Funeral Trust. This is the organization that funeral directors set up to hold prepayments for funerals.  The association chose to invest the funds very aggressively and now only has money to pay out 65% of what people deposited. The funeral home that called me was caring for two individuals who had passed, and the home was trying to determine how much money the trust actually has for them.   They called me is because they found me in an internet search. (If you Google “funeral trust Wisconsin”, my website comes up.)  They hoped I could either help them or direct them to the correct place.

This shortcoming of the state funeral trust is important to those planning ahead for their end-of-life needs.  I am a long-term care planner and, as such, include protecting funds set aside for funerals as part of my work.  I help people set aside funds for their funeral using a licensed trust company who specializes in just this. The company that I use for this purpose is a licensed and bonded insurance company, required by law to retain adequate funds to cover claims. There is no cost to set up such a trust and the funds deposited earn interest.  These funds are available immediately at death, even before a death certificate has been produced, to pay all the bills in full.

There is another important reason to fund a funeral trust –many people need long term care in the years leading up to their death. This can cost as much as $50,000 to $90,000 per year or more.  If they did not plan in advance and purchase long-term care insurance to cover these bills, they may have to apply for a welfare program called Medicaid to pay for their care. Medicaid is a payer of last resort and will only cover long-term care expenses once you have spent down everything you own (house, car, checking, savings) to under $2000.  You must also cash in life insurance before Medicaid pays for long-term care.  This balance is not enough to pay for a funeral.

Medicaid does allow you to set aside money for funeral expenses, but only in an irrevocable burial trust account.  Setting these up for people who did not plan for long-term care expenses has become a large part of my work.

Death happens to everyone.  Don’t leave the bills for this to your children.  Make sure the money is there AND accessible to them when it is needed.

Long-term care happens to 70% of adults who make it to age 65. What is your plan to pay for this care when your health changes?

For answers to either of these predicaments, reach out to Romeo Raabe at www.TheLongTermCareGuy.com or call (920) 884-3030 to schedule a time to investigate solutions.  There is never a cost to investigate.

Immigration Problem, or Caregiver Problem?

Immigrant Worker Shortage
Immigrant Worker Shortage

Immigrants make up 1 in 4 health aide workers.

From the Washington Post

BOSTON — After back-to-back, eight-hour shifts at a chiropractor’s office and a rehab center, Nirva arrived outside an elderly woman’s house just in time to help her up the front steps.  Nirva took the woman’s arm as she hoisted herself up, one step at a time, taking breaks to ease the pain in her hip. At the top, they stopped for a hug.

The women each bear accents from their homelands: Nirva, who asked that her full name be withheld, fled here from Haiti after the 2010 earthquake. Dicenso moved here from Italy in 1949. Over the years, Nirva, 46, has helped her live independently, giving her showers, changing her clothes, washing her windows, taking her to her favorite parks and discount grocery stores.  Now Dicenso and other people living with disabilities, serious illness and the frailty of old age are bracing to lose caregivers like Nirva due to changes in federal immigration policy.

Nirva is one of about 59,000 Haitians living in the U.S. under Temporary Protected Status (TPS), a humanitarian program that gave them permission to work and live here after the January 2010 earthquake devastated their country. Many work in health care, often in grueling, low-wage jobs as nursing assistants or home health aides.

Now these workers’ days are numbered: The Trump administration decided to end TPS for Haitians, giving them until July 22, 2019, to leave the country or face deportation.

In Boston, the city with the nation’s third-highest Haitian population, the decision has prompted panic from TPS holders and pleas from health care agencies that rely on their labor. The fallout offers a glimpse into how changes in immigration policy are affecting older Americans in communities around the country, especially in large cities.

Ending TPS for Haitians “will have a devastating impact on the ability of skilled nursing facilities to provide quality care to frail and disabled residents,” warned Tara Gregorio, president of the Massachusetts Senior Care Association, which represents 400 elder care facilities, in a letterpublished in The Boston Globe. Nursing facilities employ about 4,300 Haitians across the state, she said.

“We are very concerned about the threat of losing these dedicated, hardworking individuals, particularly at a time when we cannot afford to lose workers,” Gregorio said in a recent interview. In Massachusetts, 1 in 7 certified nursing assistant (CNA) positions are vacant, a shortage of 3,000 workers, she said.

Nationwide, 1 million immigrants work in direct care — as CNAs, personal care attendants or home health aides — according to the Paraprofessional Healthcare Institute, a New York-based organization that studies the workforce. Immigrants make up 1 in 4 workers, said Robert Espinoza, PHI’s vice president of policy. Turnover is high, he said, because the work is difficult and wages are low. The median wage for personal care attendants and home health aides is $10.66 per hour, and $12.78 per hour for CNAs. Workers often receive little training and leave when they find higher-paying jobs at retail counters or fast-food restaurants, he said.

The country faces a severe shortage in home health aides. With 10,000 baby boomers turning 65 each day, an even more serious shortfall lies ahead, according to Paul Osterman, a professor at Massachusetts Institute of Technology’s Sloan School of Management. He predicts a national shortfall of 151,000 direct care workers by 2030, a gap that will grow to 355,000 by 2040. That shortage will escalate if immigrant workers lose work permits, or if other industries raise wages and lure away direct care workers, he said.

Nursing homes in Massachusetts are already losing immigrant workers who have left the country in fear, in response to the White House’s public remarks and immigration proposals, Gregorio said. Nationally, thousands of Haitians have fled the U.S. for Canada, some risking their lives trekking across the border through desolate prairies, after learning that TPS would likely end.

Employers are fighting to hold on to their staff: Late last year, 32 Massachusetts health care providers and advocacy groups wrote to the Department of Homeland Security urging the acting secretary to extend TPS, protecting the state’s 4,724 Haitians with that special status.

“What people don’t seem to understand is that people from other countries really are the backbone of long-term care,” said Sister Jacquelyn McCarthy, CEO of Bethany Health Care Center in Framingham, Mass., which runs a nursing home with 170 patients. She has eight Haitian and Salvadoran workers with TPS, mostly certified nursing assistants. They show up reliably for 4:30 a.m. shifts and never call out sick, she said. Many of them have worked there for over five years. She said she already has six CNA vacancies and can’t afford to lose more.  “There aren’t people to replace them if they should all be deported,” McCarthy said.

Who will care for you?  How much will they be paid?  When you cannot hire enough workers to fill the job, wages go up.  Can you afford long-term care today?  How about in 15 or 30 years when the costs have doubled or quadrupled?  I can, due to the LTC insurance I bought years ago.  Its benefits get larger every year by 5% compound to (just) keep up with increasing costs for care.  If you don’t have yours yet, call (920) 884-3030 and talk to Romeo Raabe, TheLongTermCareGuy.com.  Or look us up online first.  Don’t wait until your health changes and you can no longer get this insurance.