For many of us, the holidays are a wonderful time to celebrate family. It’s a time to reconnect with far-flung loved ones and revisit familiar rituals with parents and siblings. But, when adult children return home after long stretches away, they can discover changes that could be the beginning of a decline in a parent’s health that may need intervention.
It’s a major reason why the holidays are the busiest time of year for long-term care admissions for homecare, assisted living and nursing homes. Especially for those who live away from their parents, changes in behavior and the condition of a childhood house can be more obvious than to those who live with them every day. It can take a trained eye to know what to look for in the condition and actions of an older parent that can help decide if it’s time to consider professional care:
- Physical deterioration: Look for signs such as significant weight loss, balance issues and falling, loss of strength and stamina, and other losses of “Activities of Daily Living” known as an ADL such as ability to shower or toilet, dress, or eat independently.
- Mental Deterioration: Do not chalk up loss of memory or confusing names, dates and locations as just a “senior moment.” Cognitive deterioration is an important warning sign that you should be on the lookout for dementia and Alzheimer’s. These conditions can worsen quickly and can lead to many physical breakdowns and safety issues.
- Lifestyle Deterioration: Is the home not being kept as neatly as in the past? Are things oddly out of place (a houseplant in the fridge, pots and pans in the bathtub), or do you see signs of physical damage (the car crashing into a fence or the wall of the garage, burn marks on the kitchen wall from a flash fire)? Long-term care is both a matter healthcare and
Most families are not prepared for this and don’t have a plan or resources, making the decision more traumatic and heartbreaking for everyone. It doesn’t have to be that way. Every family should be talking about this now and exploring their options for care and the finances. Families should construct a three-point plan for how they will discuss this matter with their loved ones and then act:
- Siblings and spouses need to be on the same page about this situation and next steps
- Everyone needs an assigned job
- Understand different types of care and how to pay for it (Medicare v. Medicaid / Private Pay / Insurance options)
Once everyone is on the same page, ease into the discussion. Don’t just jump to an announcement that it’s time to move into a nursing home. It also helps to bring in an objective third-party expert opinion. Look for a certified geriatric care planner in your area. The Aging Life Care Association has a website where you can search for one in your area. They know how to evaluate the situation and then lay out care and financial options. If your loved one is arguing against getting homecare or making the move into assisted living, there are some positives to balance the loss of independence you can point out:
- Are they too isolated now? This can increase socialization and transportation
- How well are they caring for themselves? This can improve hygiene and nutrition
- Are they in danger living alone? This can significantly improve their safety
- Are they properly taking care of their health? They will receive professional health care and assistance with medications
Are you prepared for the costs?
The three primary ways to pay for care are with Medicare, Medicaid, or private pay through insurance, savings or assets.
- Medicare is an age-based program that will cover the first 100 days of rehabilitation care in a licensed skilled nursing facility upon direct discharge from a hospital.
- Medicaid is a means-based program which means to qualify an applicant must meet both standards of medical necessity and be below set asset and income levels below the poverty line. Applying for Medicaid can be a challenging process that requires the applicant to submit detailed medical and financial records. Medicaid will look back five years at financial records to make sure that assets have not been hidden or transferred to family members.
- Private pay primarily comes from an individual and/or a family’s savings, insurance, assets, and income. People that are private pay can choose any form and location of care that they want.
Here are three tips to help families’ better plan:
- Remember, there are many levels of care available. Among the myriad options: a few hours of in-home assistance each week, residential communities that provide daily assistance with meals, laundry, etc., all the way to a nursing home that provides round-the-clock care. Generally speaking, finding ways to keep your loved one at home for as long as possible is the least disruptive – and least expensive – option.
- Avoid resorting to Medicaid if at all possible. According to the Genworth 2018 Cost of Care Survey, nursing-home care costs start at $5,000 to $12,000 a month, depending on where the patient lives. It is a price that is often beyond the means of people otherwise considered financially healthy. Many families turn to Medicaid to pay for nursing home care, but it comes with many restrictions, including choice of facilities. In a situation where one spouse is healthy and the other is not, the spouse living independently will also face restrictions on the amount of assets he or she can retain, for instance, as of 2017, a maximum $3,022.50 for monthly maintenance, according to the National Center on Law & Elder Rights.
Don’t simply stop paying on a life insurance policy to save money. Anyone who owns a life insurance policy could potentially qualify to exchange their policy for a tax-advantaged Long-Term Care Benefit Account, through GWG Life. The Benefit Account is kind of like an LTC Health Savings Account (HSA) funded by the policy settlement. It can be used to pay for any form of care a person wants at whatever amount is needed on a monthly basis for as long as there are funds in the account. It is a tax-advantaged, Medicaid qualified spend down and a much better use for an unneeded life insurance policy than to lapse or surrender it.
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