Protecting Money from Nursing Homes
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.
Hiring Help For Mom
Reprinted from the Washington Post Carolyn Hax column
On Abruptly Facing An Elderly Relative’s Need For Care
I sometimes supplement my income by senior-sitting those in need of temporary help. Recently, a family offered me a position to live 24/7 in their mother’s home as her aide, caregiver, housekeeper, cook, laundress, hairdresser, chauffeur, med-tech, and personal care provider. The “terms” (their word) were: free room and board, two full weekends off each month, most holidays off and a “stipend” (their word) of $100 a week.
Essentially, they want the Care Fairy to come see to their mother and the house, and will give the Care Fairy a weekly allowance for the privilege. This family is desperate, of course. They have slipped right on over into the fantasy world between Denial and Magical Thinking, unable to grasp the situation upon them. So, I did not overreact when I said no thank you. I was polite, but they were stupefied that I was not interested.
Adults in the sandwich generation: This is your future. The time to talk about it is now, not the day after “something happens”. You might not have a legal right to see your parent’s financials, but you have the moral right to ask to be part of their advance planning and directives. Do it before feelings are hurt and tempers flare, and before you later offend or insult every friend, neighbor, acquaintance, or extended-family member in your search for help.
TheLongTermCareGuy input:
Long-Term Care is a lot of work. It is expensive to hire it done, but many adult children cannot afford to leave their work and families to provide for loved ones. LTC insurance is the least expensive and best way to address this problem, if you look into obtaining it while healthy and preferably below age 55. You pay dollars and get thousands of dollars later when care is needed. For those who do not plan in advance, there are still ways to help – even if already spending down to Medicaid. You can try to figure this all out yourself, or come see an expert who can help. Your choice.
For more information contact www.TheLongTermCareGuy.com
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]
How To Care For Two Parents at Once Without Going Broke
“The biggest challenge of all is holding onto your patience.”
Reprinted from Money Magazine
For years, Madeleine Smithberg has been at the forefront of American comedy as co-creator of “The Daily Show” and a talent coordinator for “Late Show with David Letterman.”
That sense of humor was especially handy during the last few years. That is because Smithberg had to cope with not one, but two elderly parents in rapid decline.
“It’s heartbreaking,” says Smithberg, 56, who heads a production company in Los Angeles. “And yet it’s invisible, because nobody talks about it.”
“It’s like having toddlers,” says Smithberg, whose father passed away in 2014 after she moved her parents to Los Angeles. “They’re hot, they’re cold, they’re hungry, they ask repetitive questions, and their needs become the most important thing in the world at that second… The biggest challenge of all is holding onto your patience.”
According to a new study by Northwestern Mutual, the childrearing comparison is apt: 59% of Americans feel that taking care of two parents between ages 85 and 90 would be even harder than handling two kids between ages 3 and 5.
Caregivers may also have kids of their own. In that case, it’s not just the “Sandwich Generation” – it’s a Triple-Decker.
The Northwestern Mutual report found that 38% of those surveyed have not planned at all for handling the financial burdens of caring for elderly parents.
The costs can be gigantic: National median costs for an assisted-living facility are now $43,200 annually, according to insurer Genworth Financial in its annual Cost of Care study. A private room in a nursing home? $91,250.
That is more than enough to blow up any financial plan. The following is advice on how to care for your parents without going bankrupt yourself.
Long-Term Care
“Long-term care, long-term care, long-term care.” That’s the simple advice from Smithberg. Her father had taken out coverage for himself and his wife, which she calls “the best thing he ever did.”
Long-term care insurance covers expenses for nursing home or home care if you become incapacitated – most of which is not covered by Medicare. The coverage, like the care, can be extremely expensive, and to be sure, it did not cover all of Smithberg’s parents’ assisted-living costs. But, combined with their own life savings, the policy has meant that she has not yet had to dip into her own savings to pay for their care.
Have the Talk
With the holidays right around the corner, it is one of the few times of year when far-flung families tend to gather in one place. Don’t let the opportunity slip by to discuss your parents’ expectations, should illness arrive. Find out if they have advance directives – documents that spell out what treatment they would and would not want during a life-threatening health crisis. Make sure you establish who has power of attorney, should they need someone to make important decisions.
“It’s the perfect time to have this kind of conversation,” says Kamilah Williams-Kemp, Northwestern Mutual’s vice president of long-term care. Her spouse’s grandmother lived to 102, and her mother-in-law has been diagnosed with Parkinson’s.
Consider a Reverse Mortgage
Reverse mortgages allow homeowners aged 62 and above to borrow against their home equity and to receive either a lump sum, a series of monthly checks or a line of credit that can be tapped as needed. The upside of a reverse mortgage? With the bank paying you every month, instead of the other way around, that check can help cover costs for in-home caregivers.
Tom Davison, a financial planner in Columbus, Ohio, is working with a 90-year-old woman whose daughter moved in with her as a caregiver. “A reverse mortgage could help (the daughter) pay her the wages she has given up,” Davison said.
Be sure to have proper documentation that the child is actually employed by the parent. If not, and later Medicaid is needed, Medicaid will count each payment to the child for care as a gift, disqualifying the parent from Medicaid. rraabe
The downside, of course: The family home will eventually become property of the bank.
The proceeds from the reverse mortgage can also be converted to an income for life – but NOT like an ordinary annuity which uses your average life expectancy. When health is not good and life expectancy is less than “average” then a company that takes that poor health, and “shorter than average” life expectancy into account gives a much larger monthly payment. rraabe
Get Help
Your first instinct as a child may be to drop everything and handle all your parents’ needs yourself. But if it comes at the cost of your own career, think about the ripple effects – on your retirement savings, on the needs of your own kids, even on your own sanity.
With Americans extending their lifespan – 76.4 years for men, 81.2 years for women, according to the National Center for Health Statistics – this is a family challenge that won’t be going away anytime soon.
Denver financial planner Kristi Sullivan recommends hiring a case manager to do the heavy lifting.
“For an hourly fee, these people can handle tasks quickly that it might take you hours to do – scheduling doctor’s appointments, handling medical payments and dealing with insurance, helping find a good nursing home or in-home care,” Sullivan says. “Spending this money may seem expensive, but it’s less than putting someone’s career on hold to become a full-time caregiver.”
For more strategies, financing options, or ways to deal with the costs of Long Term Care even if not planned for in advance, contact www.TheLongTermCareGuy.com
A Retirement Riddle Answered, Or Not?
Last week a well known mutual fund company attempted to answer the question of why so many retirees die with significant savings left. Is it because they wish to leave large amounts for family? Perhaps they are afraid to spend the last dime just before death? This trend suggests many retirees don’t enjoy their final years as much as they could.
Few older folks seem interested in life income annuities, which could give them a guaranteed income for life with no worries, yet they keep the nest egg close at hand and don’t invade it.
The study seems to indicate that the reason is the fear of potential long term care costs that drives retirees to clip coupons, dine out at 4pm to catch the early bird special and forego expensive trips. If it comes down to it in the last year, and they had to choose between an uncomfortable year versus a comfortable year, they would choose to spend the money on making it more comfortable.
For the upper middle class, 75th percentile of wealth, health care was regarded as a necessity and bequests as a luxury. It was also surprising that people are interested in assistance with daily living expenses, but are not interested in long term care (LTC) insurance.
Perhaps this is due to old beliefs that LTC insurance only covers nursing homes. For many years now, such coverage is good for in-home care, adult day care, assisted living facilities or nursing homes. Nearly all policies also cover “alternative plan of care” for locations or strategies that have not been invented yet, but may be in the future.
The most surprising thing about this study (to me at least) is that traditional LTC insurance can be purchased with just the interest on a portion of the savings people set aside to pay for care. Instead of leaving a significant amount of assets set aside for care, the interest check from just part of that sum could provide the insurance coverage and leave the reminder that is unspent to be passed on to family.
Years ago, I was a representative from a LTC insurance company to a large bank chain in Wisconsin. My job was to show the stockbrokers there how to address LTC funding. I would attend teller meetings and ask if the tellers knew clients who withdrew $5000 or $7000 a month, every month. Every hand went up. My next question was what they spent it on and the answer in every case was a spouse needing LTC. With today’s costs reaching or exceeding $9000 a month, the problem is even worse.
There are many strategies to deal with the costs of LTC, but the least expensive is LTC insurance with a built in 5% compound inflation factor on the amount available for care. This will keep up with the costs of care over the years and frees up your life’s savings to experience life with – instead of waiting for that last year or two. This coverage is, in most cases, less than is typically thought it would cost (if chosen appropriately). For more information, visit www.TheLongTermCareGuy.com
Thanksgiving is Coming, How is Your Family Doing?
Thanksgiving comes around every year about this time. Families get together, hopefully getting along. Sometimes it is the one time a year everyone sees how the older members of the family are doing since last year.
For some families, it will be a difficult time when they realize that grandma or grandpa are not as sharp as they used to be. Perhaps it is difficulty in getting around, or driving, or perhaps it is in confusion that seems to be getting worse and frustrating the person no end.
Well, the family is all together, so let’s discuss what to do. Perhaps nobody is willing to start the discussion, ignoring the elephant in the room. Or perhaps someone attempts to make suggestions and is quickly shot down.
Talking about losing independence is never easy. Help may be offered and declined since “I can do it myself”! In any case, some family members can see that a problem is evident and wonder what to do about it.
A big part of searching for solutions is learning what options are available. All sorts of support services exist, to help people in their homes, day care several times a week, or even an assisted living facility. Many of these have pools or hot tubs, and most now offer happy hour one afternoon a week to help with socialization. However, who will bring up the topic and risk the wrath of the loved one you all care about?
All of the options can be expensive. The good news is that only about 15% to 20% of LTC is done in nursing homes now. Home care and assisted living facilities cost half or less than a traditional nursing home. However, $1500 to $4500 per month will strain most budgets or put a large dent in the family funds rather quickly. Perhaps it might be prudent to learn what financing arrangements for LTC services are available.
Medicare does not pay for LTC. Medicaid will, but only once the person has spent-down to impoverishment and cashed in any life insurance. There are other, better options available. LTC insurance, if purchased while still healthy is the least expensive way to address this, but even after the need arises, there are other strategies. In a worst case, there is still the option to move some money to family without Medicaid penalties. You simply need to consult an expert in this area and learn what options can work for you.
More information is available at www.TheLongTermCareGuy.com
More Bad News For The Sandwich Generation – Filial Responsibility Laws
The sandwich generation are the folks who are currently raising teens, paying for school, and taking care of their parents as well. This causes much missed work, missed work opportunities, missed events with children, and general exhaustion. How could you possibly accept a promotion requiring a move when you are taking care of an aged loved one here?
Now there is another worry to consider, Filial Responsibility Laws. 30 states have them and they state that adult children have a duty to provide necessities for parents who cannot do so for themselves. This includes long term care (LTC)!
Here is a list of the states that have such laws: Alaska, Arkansas, California, Connecticut, Delaware, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Maryland, Massachusetts, Mississippi, Montana, Nevada, New Hampshire, New Jersey, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Dakota, Tennessee, Utah, Vermont, Virginia, and West Virginia. If your state is not listed here you are NOT out of the woods. If you have parents living in one of those states, you could become responsible for their bills including the cost of home care, assisted living or a nursing home.
Judges use a number of factors when determining the adult child’s responsibility to cover the indigent parent’s bills. I personally thought I would never see these laws enforced, but California, New York, and Pennsylvania have each had a number of cases.
You may have heard the various rumors of shortfalls in government budgets. You may also be aware that the baby boomers are turning 65 at a rate of 10,000 a day and will for the next 18 years. Where do you think the money will come from to pay for the LTC these people will need, if they do not have the funds, or insurance to pay their own bills?
You might view this as a way to get even with your kids, like the bumper sticker that says we are spending our children’s inheritance. But do you really want to bankrupt them from their financial security? Perhaps you should investigate LTC insurance for yourselves, if you are still able to qualify for it. for more information, visit www.TheLongTermCareGuy.com