Protecting Money from Nursing Homes
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?
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?
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.
Will Your Empty Nest Sadness be Solved By Mom Moving In?
I listened to a public radio program this morning about empty nesters and what they do to fill the void when children finally leave the nest. A number of callers spoke of how a parent moved in when they could no longer function at home on their own anymore.
Having a parent move in when they need care may sound cozy, and for some families it is a wonderful experience. Mom may be a pleasure to host, she may help with gardening, cleaning house, and perhaps even assist with cooking.
On the other hand, she may eventually need help with bathing, toileting, medication management, and if there is any dementia, a host of other cares that will become necessary.
Sundowning is one concern several callers mentioned. This is when the dementia is worse in late afternoon and evening as logic and reasoning disappear. Getting someone calmed down and to bed can be as difficult with an adult as it was with children. We all remember driving a child around in the car until they fell asleep, and this may now become necessary again, regardless how much gasoline costs.
When someone you love and care about strongly resists bathing and does not want to be in water it can be quite frustrating. Worrying about their falling when you are not watching them closely prevents any chance of your relaxing. This can trap you in your own home as a 24 hour a day, unpaid caregiver.
Sometimes Mom or Dad have funds and can compensate you for your work as a caregiver. One of my clients recently contacted me with questions on a problem this caused.
His mother had lived with them for 18 months, and they provided all of her care in exchange for payment of $3000 per month. This worked well until her care became simply too strenuous for the two of them to handle. At that point they moved Mom to an assisted living facility where the 24 hour caregivers could handle all her needs.
About a year later Mom’s savings ran out and she needed to apply to Medicaid to fund her care. Medicaid requires complete impoverishment down to $2000 of assets and typically any life insurance must be cashed in as well. Medicaid also closely checks financial history to determine if any gifting was done in the 5 years prior to applying for Medicaid. Any gifts given during this time period are totaled and divided by the average cost of a nursing home to determine how long you are ineligible for Medicaid once you are down to $2000.
In this case, without a signed, dated and notarized work contract between Mom and her son and his wife, every check of $3000 for care was counted as a gift and Mom became ineligible for Medicaid. Son now digs into his retirement savings to pay back Mom the money she paid them for care. This of course triggers additional income taxes for son as retirement funds are withdrawn.
While it is a loving gesture to have Mom or Dad move in with adult children when care is needed, you need to ask yourself, are you emotionally and physically able to undertake what often becomes full-time 24 hour per day care?
For some the answer is yes, and becomes a wonderful experience. For many others what started as a new adventure becomes tedium and a physically impossible job better suited to professionals.
Your parents may not have the money to pay for care, nor the health to purchase Long-Term Care insurance. Let this be a lesson to those of us who do have the health to purchase this insurance. The premium is far smaller than the cost of the care it pays for.
If you do decide to investigate Long-Term Care insurance, do so with someone who understands how and where this care is provided, as well as accurate current costs. Bear in mind that when one can no longer use the fun toys and travel, a portion of income can go towards the cost of care. Interest on savings can help as well without depleting principal. Thus most people need less of the insurance than they might first anticipate.
While you might hope that this will never happen to you, Health and Human Services tells us that by the time we reach age 65, fully 70% of us will need Long Term Care.
At TheLongTermCareGuy.com we have over 23 years experience in guiding people with this insurance. Let us help you investigate, every situation is unique. Call us at (920) 884-3030 or (800) 219-9203 or look us up online at www.TheLongTermCareGuy.com
Think You Are Too Young To Worry About LTC? Think Again!
I just read that the Centers For Disease Control and Prevention (CDC) says “The percentage of adults aged 45 to 64 years who reported needing help with activities of daily living such as eating, bathing, dressing, or getting around inside their residences has increased nearly 50% from 2000 to 2015. This was published in their weekly Morbidity and Mortality Weekly Report on August 26th.
For years it has been known that 40% of the people needing Long Term Care (LTC) services in this country are between the ages of 18 and 64. LTC is not something that people can ignore until age 85. Just like car insurance, LTC insurance must be purchased while you are healthy – so you have it when you need it.
By 60 years of age, 25% of us cannot qualify healthwise to purchase LTC insurance. The great majority of people cannot afford to pay for such care out of pocket or savings for very long. This leaves them no alternative but to apply for a welfare program called Medicaid.
Medicaid will only pay for LTC when you can prove that you are completely impoverished. In most states that means you have less than $2000 left to your name and have cashed in your life insurance as well. A married spouse can retain use of the home and car but this goes back to the state – not your heirs – after last death.
LTC needs can last for many years. Alzheimer’s is only one of 68 different types of dementia. By age 65, one in eight have it. By age 75 it is one in four and by age 85 it is half of us.
This brings up another study published in the Journals of Gerontology: Medical Sciences that says “Older adults who do not exercise often – or do not exercise at all – have a 50% greater risk of developing dementia as they age”. Anyone with diabetes also faces a significantly higher risk of developing Alzheimer’s.
Will you wait until it is too late to plan for your LTC when your health changes? Or will you proactively investigate solutions while they are still available? The ability to pay for care not only prevents impoverishment, but gives you choices as to how and where your care will be delivered.
Give TheLongTermCareGuy.com a call to meet and see what you can do for yourself. We are experts who have done nothing but work with LTC financing for 23 years now. There are solutions for almost any budget. (920) 884-3030 or (800) 219-9203
LTC Insurance is Too Expensive!
Lately I have seen clients shown proposals to purchase Long-Term Care insurance with premiums exceeding $10,000 a year for a couple. This is ridiculously expensive for most couples in their fifties, and is probably because the insurance amounts are way too large to be appropriate.
Some insurance agents who “dabble” in LTC insurance products think that everyone needs enough insurance to cover the entire bill. Perhaps they themselves have zero deductible car insurance, which makes no sense either.
If we have a car accident, most of us have some deductible that we will pay before the insurance pays the rest. The larger the deductible, the lower the insurance premium. With most car accidents, our lifestyle does not drastically change, but when LTC is needed, it does.
If one of a couple needs LTC, they are probably not driving anymore. Thus fewer cars, less motorcycles, boats, campers, snowmobiles, ATV’s, etc. will be needed. There will be less trips to Branson, Disney World, cruises, even less going out to dinner when one has a difficult time going anywhere.
Professionals who specialize in LTC planning take these things into consideration. We try to help our clients predict how much of their monthly income is actually required to pay the basic bills, and with less toys and travel – how much of the bill for LTC they can pay out of pocket.
In addition to monthly cash flow, many people can also contribute the interest their savings earn, without touching the principal. Often, the total between available cash flow and monthly interest will cover a significant portion of LTC costs. Only the shortfall needs to come from LTC insurance.
Here is an example for a 65 year old couple. They want to be able to pay for home care and assisted living facility care without using up their life savings. If they do not need to support 2 cars, the extra Corvette “summer car”, the boat, and they understand that when one cannot travel, that expense drops to zero as well, they can pay the majority of the cost of home or assisted living facility care.
Many people plan for just those costs as very few people today need the care of a nursing home, especially if they can afford their home or assisted living care.
In their case it is determined that an additional $2000 a month from LTC insurance will suffice. At age 65 for each, and both in good health, they can purchase that coverage with a 10 year benefit when care is needed, including an automatic 5% compound inflation rider on the monthly benefit for less than $2000 a year each.
With the automatic, built in 5% compound inflation on the benefits payable, by age 85, a 10 year length of claim can give them over $850,000 from the LTC insurance to pay for their care.
Let’s review, at age 65 they purchase LTC insurance that will give them over $850,000 to pay for care over 10 years starting if care is needed at 85, for $1900 a year. Is a premiumk of less than $2000 a year expensive for that?
If you have been shown sky high premiums for LTC insurance, you need to shop around before you buy. Talk to someone who has over 23 years experience in planning for LTC, and can help you size coverage appropriately. Just give us a call at TheLongTermCareGuy.com at (920) 884-3030 or (800) 219-9203 and lets investigate. But don’t wait until your health fails, becasue then it may be too late, for you.
Where’s The Disconnect
This post, in it’s entirety, is reprinted from a chapter in the book “Surviving Alzheimer’s with Friends, Facebook, and a Really Big Glass of Wine”, written by my very good friend Honey Leveen, a first rate Long-Term Care insurance agent in Houston, TX
“Where’s the Disconnect?” by Honey Leveen, The Queen, by Self-Proclamation, of Long-Term Care Insurance
Insurance disclaimer: The following is based on the author’s personal experiences and opinions.
Much of the legacy we leave may be measured by how honestly we’ve dealt with life’s most painful truths. Often, such truths are the most obvious, yet hardest to see clearly.
I’ve specialized in long-term care insurance (LTCi) since 1990. That’s a long time. I’ve seen a few hundred of my nearly 3,000 clients collect from policies I’ve sold them. This is just the tip of the iceberg, however; many more will need to collect from their LTCi as time goes on.
I see scenarios just like Dayna’s [as described in Surviving Alzheimer’s] play out again and again. For different reasons, when a parent needs LTC, family members who’ve always gotten along well may find themselves at odds with each other. It is exactly as Dayna describes. The absence of sufficient, readily available money to swiftly access long-term care (LTC) aggravates an already highly stressful situation.
People who own LTCi also commonly suffer familial dysfunction similar to Dayna’s. What makes things so different for them is that their LTCi policies pay out significant, meaningful amounts of money when LTC is needed. This is often a huge game changer. LTCi tends to subdue the emotional discord Dayna describes. Relationships don’t suffer as much, and outcomes are better. The money people collect from LTCi provides them with dignity, choices, access, and options they would not have otherwise had.
Sadly, most of us still do not own LTCi. Sadder still, it is too often well-educated people with good incomes and a whole lot to lose who choose to be unprepared for LTC.
Such people come up with what they think are fabulous excuses to avoid discussing what might happen to them at the end of their lives. There seems to be a disconnect between our intellect and our emotions when it comes to LTC planning.
According to www.longtermcare.gov and other reputable sources, at age 65, there’s a 70% chance of needing LTC. These odds go up with each year we age. Visit Genworth’s Cost of Care Calculator (find it in the Resources area of www.honeyleveen.com) to see just how expensive LTC is in your locale.
Most LTC in the US is provided on an unpaid basis, disproportionately by women, who often have to sacrifice their careers, savings, and relationships to provide care.* LTC already costs American families dearly, yet the worst of this crisis is yet to come.
As former First Lady Rosalynn Carter said, “There are only four kinds of people in this world: those who have been caregivers, those who are caregivers, those who will be caregivers, and those who will need caregivers.”
Here are some simple responses to major misconceptions about LTC and LTCi. More complex answers are found on www.honeyleveen.com or by calling me, at no obligation:
LTCi is too expensive. Not true. What may be expensive is needing LTC for anything but a short time and not owning LTCi. Policyholders usually collect back all premiums they’ve paid over the life of their policy in a few short months. Premiums are customized for each person and can be made to fit into almost anyone’s budget. *
The government pays for LTC. The type of LTC the government pays for is not what you would freely choose. *
Medicare covers LTC. No it doesn’t! Medicare covers acute medical problems and a restrictive, conditional amount of home or in-patient rehabilitative care that most people don’t qualify for.*
The LTCi industry is threatened. It’s true that the number of carriers selling LTCi has shrunk; there are valid reasons.* Policyholders are not in danger.* LTCi carriers remain staunchly committed to the market. They realize the LTC crisis and oncoming Senior Tsunami isn’t going away any time soon, and are in it for the long run.*
LTCi only pays for nursing homes. The opposite is true. The great majority of LTCi policies pay comprehensively, for care at home, in adult day care, assisted living, and nursing homes. They enable you to increase the odds you will not need LTC provided in a nursing home.*
Here are some of many silly excuses smart people give me to avoid conversing about LTCi while they’re healthy and can find reasonable premiums:
My wife will take care of me. Really? Your wife will be eager and physically capable of helping you bathe and dress, for example? You don’t mind the thought of her last memories being about the physical, emotional and financial burdens of caring for you?
That won’t happen to me. Really?
My kids will take care of me. Really?
I’ll kill myself.
I can’t afford LTCi. Many people claim LTCi is too expensive, despite the fact that we tailor LTCi premiums to fit into most people’s budgets. Situations like this one happen frequently: an acquaintance tells me she can’t afford LTCi premiums. This person’s mother needed LTC for an extended length of time, at great sacrifice to the family. A week later this person announces she is making a two week trip to Mt. Everest Base Camp/African photo safari/Tahiti or another exotic locale, or is buying a top-of-the-line car/kayak/audio equipment, etc. She has the money to do that but can’t afford LTC premiums. Where’s the disconnect?
Here’s another common scenario: I get incoming calls with Caller ID stating: “METHODIST HOSP RE-HAB”. The caller is the daughter or son of someone who’s just broken their hip or suffered a stroke. They ask me to come sell their parent LTCi. I have the unpleasant task of trying to tactfully explain that their parent is uninsurable. Sometimes the child is incensed by this news. I suggest the child is of ideal age to find reasonably priced LTCi for themselves; this might be a wise idea if they want to assure a similar scenario doesn’t play out when at the end of their lives. The child is normally not interested. The reason is that the family is in the worst kind of turmoil, duress, and dysfunction. They are scurrying around trying to cobble together LTC for their parent, and there isn’t sufficient, readily accessible money to pay for it. This is the scenario Dayna and I urge you to avoid by doing reasonable, responsible LTC planning, now.
What all of my LTCi clients have in common, regardless of their incomes, is the ability to honestly, openly discuss LTC in advance. Most of my clients have had firsthand experiences similar to Dayna’s. They’ve learned from them, and taken action to avoid the consequences of not being prepared for their own long-term care.
If you need to investigate whether LTC insurance is appropriate for you – or not, give www.TheLongTermCareGuy.com a call at (920) 884-3030 and lets see.
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.
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
How Your Home Can Help You Pay For Long-Term Care
Yes, it is possible for your home to help pay for your Long-Term Care (LTC) and possibly help keep you in your home longer. For many seniors, the home equity is their largest asset. Using that asset to help keep you at home versus in a LTC facility can make sense. There are a number of strategies on how this might happen.
First, let’s review the Medicaid rules for paying for LTC. Medicaid is the fall back option for people who cannot pay for LTC themselves. If you are single, you must spend down EVERYTHING you have to $2000, including the sale of the home, auto, IRA’s, cash in life insurance over $1500, pretty much devastating your finances. If married, the spouse at home can retain use of (Medicaid will recover later, so children may not inherit) the house, one vehicle, some savings and income.
Since the house will be subject to estate recovery, where Medicaid takes it after last death preventing your children from inheriting it, why not use it to pay for your care – at home or in a facility. A reverse mortgage can facilitate removing the equity in the house and converting it into a check you can cash. You can then spend the money until it is gone, OR…..
There is a way to convert the cash you removed from the house into an income for life. Typically, this is called a life income annuity, but there is a twist for LTC. When LTC is needed, it is probably true that your life expectancy is less than others of your chronological age. Most annuity companies only take into account your age and gender. There is one that has a different twist that makes it much more beneficial when LTC is needed.
This one takes your [poor] heath and thus shorter than average life expectancy into account. By doing so, it may be possible to get a much larger check each month for life. Since your life expectancy is less than average, you can receive a significantly larger check each month, and use that to either pay for home care and stay in your house, or pay for an assisted living or other LTC facility that might not have been affordable to you otherwise.
This lets you use the home equity, which would otherwise be reclaimed by Medicaid after last death, to pay for the LTC you need, and giving you choices of how and where that care is delivered. Its your home, its your equity, why not use it for your care as you wish?
If you are healthy, planning for LTC needs, and do not have the cash flow to pay the premium for LTC insurance, why not use that home equity to purchase the LTC insurance you do not think you can afford. Once you have the coverage, you can use it to pay for care at home, or in a facility, your choice. Since the alternative is to spend the home equity until you are on Medicaid, and remaining equity going to the state after death, versus your children, it makes sense.
Lastly, if the home is going to go anyway, we here at TheLongTermCareGuy.com have ways to save some of that home equity to pass on to your children (and their spouses) that Medicaid allows. Typically, any gifts given in the past 5 years will disqualify you from receiving Medicaid, but there is a provision that will allow you to protect some for family. We can help you accomplish this.
So, when LTC becomes necessary, and you might think all is lost, there may still be options to be able to pay for care and receive that care where and how you want. It is even possible to protect some assets to pass on the family. Simply call TheLongTermCareGuy.com for help at (920) 884-3030 and schedule a time to learn your options.