Long-Term Care 101

Long-Term Care 101 

Today, many Americans  are faced with planning and paying for their own long-term care needs and the needs of the ones they care about.  Long-term care should be (ideally) a process that begins with a plan involving the person for whom care will be provided and the ones who will ensure its management.  The Administration on Aging (AOA) indicates that someone over 65 "has almost a 70% chance of needing some type of long-term care services and supports in their remaining years."  That being said, long-term care isn't just for the aged or elderly.  In fact, many Americans under the age 65 who are mentally or physically disabled require long-term care planning and assistance.  In planning for long-term care, be prepared to answer the following questions: What is long-term care? Who will need long-term care?  How long is long-term care?   How will I pay for the costs?  Who do I want to provide it?  Where will it be provided? When do I start planning?

What is long-term care?

Long-term care is coordination of and assistance with medical care and daily living tasks up to and including: meal preparation, hygiene, transportation, household upkeep, financial management, medication assistance, and legal decisions, to name just a few.  The spectrum of long-term care should expand or contract to meet the needs and capabilities of the loved one in need of care.

Who will need long-term care?

As mentioned above, the data is clear that a growing number of Americans will need some form of long-term care assistance.  In fact, the AOA reports that "In the 2000, almost 10 million people needed some form of long-term care in the United States. Of this population, 3.6 million (37%) were under age 65 and 6 million (63%) were over age 65..."  With that in mind, everyone should plan for their long-term care needs.  Most people will need help in at least one of the many areas that long-term care covers.  Therefore, its important to plan before advance planning is not possible.

How long is "long"-term care?

The answer, as with most things, is--it depends.  Statistically speaking, men who are in need of long-term care will need it for 2.2 years versus women who require longer care at 3.7 years. Those numbers are averages--meaning that any one particular person's needs may be smaller or greater.  To know and understand what your loved ones needs are and may be will depend on a care assessment and recommendations of health, financial, and legal professionals.

How will I pay for the costs?

Insurance:

Medicare v. Medicaid 

It is not uncommon for the insured or the family of the insured to be uncertain of what insurance may be currently in place.  In fact, many people throw out the words "Medicare" and "Medicaid" as though they are synonymous and THEY ARE NOT.  Medicare is not an insurance program designed to provide for long-term care needs.  In fact, generally speaking, Medicare only provides for skilled-services or rehabilitative services.  In a long-term care facility, Medicare will cover skilled-services for a period not to exceed 100 days.  For home healthcare service through Medicares, a doctor must certify that someone is need of one or more of the following: intermittent skilled nursing care, physical therapy, speech-language pathology services, or continued occupational therapy.  In contrast, Medicaid has a dedicated long-term care component for persons who meet disability and financial requirements.   At 1.5 million nursing home residents and 2.9 million community-based residents according to the Kaiser Family Foundation, Medicaid provides a substantial amount of care to the elderly, aged, and disabled in need of long-term care.

Veteran's Benefits

Contingent upon a veteran's status, service availability, clinical need, and enrollment, Veterans Home and Community Based Services are part of the VA Medical Benefit Package.  Also, Nursing Home and Residential Options are available for eligible veterans, subject to eligibility guidelines and enrollment.  Certain dependents and survivors may be eligible for services and benefits as well.

Long-Term Care Insurance

Long-term care insurance is designed to cover the costs of long-term care and can be used in combination with private funds to leverage more desirable placement and services alternatives.  Long-term care policy coverage is one option among many, but may easily be missed due to rising premium costs based on the insured's age making it financial difficult to purchase, or a failure to qualify due to advanced medical conditions that prevent underwriting of the policy. Also, it is key to remember that not every long-term care policy is made alike, even among the same insurance company.  Some terms of long-term care policies are negotiable like making the daily pay rate of the policy adjustable for inflation.

Private Pay

Private pay is an individual's ability to cover long-term care costs from his or her own resources.  Frequently, private-pay resources are leveraged in concert with other insurance benefits to provide for long-term care needs.

Who do I want to provide it?

Many Americans receive care from family members and friends.  However, what is less common is a conversation in advance about who those person(s) will be.  It is impossible to highlight how important it is to have discussions with the persons you or your family would like to serve as caregivers--desire alone will not ensure an ideal choice.  A long-term care provider should be a person or service provider that you know and trust. 

Where will it be provided?

Many Americans hope that they and their family will be able to live in the family home or with other family for as long as possible.  Under certain conditions, that is possible; however, planning and level of care have a lot to do with where long-term care may be provided.  There are a spectrum of living arrangements, apart from the home, including: independent living, assisted living, intermediate care/nursing facility, and skilled nursing facility. These choices are available or not based on the level of care the care recipient requires. Here is some guidance from Medicare on how to choose a home health agency or a nursing home.

Here are a few resources to begin the search near you:

Nursing Home Compare: (Contains a comparison of nursing home ratings for every Medicare and Medicaid facility): http://www.medicare.gov/nursinghomecompare/search.html?AspxAutoDetectCookieSupport=1

Home Health Compare: (Contains comparison of home healthcare providers that Medicaire-certified): https://www.medicare.gov/homehealthcompare/

Eldercare Locator: (Searchable database to locate a variety of elder resources): http://www.eldercare.gov/Eldercare.NET/Public/Index.aspx

Senior Resource Guide: (Follow the link to locate a print copy near you): http://srgserv.com/publications/

When do I start planning?

Its really never too early to start planning.  The many questions long-term care raises are as much people-centered as they are financial, social service, and family oriented.  Considering personal preferences, family relationships and needs, available services, are critical bases for beginning a long-term care plan. The most important key to planning is to be active and develop a plan that is monitored as the long-term care recipient's needs and preferences change.

Mr. Henry has completed a seminar presentation series on this topic, which will be available in many venues.  To request Mr. Henry to present this series, or others on estate planning, probate, or incapacity planning, contact the Law Office of John B. Henry, III, Attorney & Counselor at Law.

This blog is designed for general information purposes only.  The information contained on this site should not be construed as legal advice or the creation of an attorney-client relationship. 

For more information, contact John B. Henry, III, Attorney at Law, to discuss your legal needs, and visit us at www.johnhenrylaw.com.

Family as Caregivers: No benefits and no resources...

Unfortunately, not every family member or friend for whom care must be provided may have independent resources.  In fact, this can be immensely distressing in the event of need for medical care.  Though the Affordable Care Act (ACA) has extended certain benefits and privileges to sectors of America that in years past had no access to healthcare, it does not mean that everyone has either taken advantage of the health insurance marketplace or were able to.  Indeed, in Texas, as there was no expansion of Medicaid, there are many Texans who remain without insurance coverage.  That being said, what do you in the event of needed medical services for a loved one who has no health insurance, no resources or benefits, or limited resources or benefits? Here are a few suggestions:

1. Find a Health Center near you.  A health center provides health and dental care to people of all ages, whether or not they have health insurance or the money to pay for health care.  The US Department of Health and Human Services maintains a database of such health centers: http://www.hrsa.gov/gethealthcare/affordable/index.html  
2. Early Childhood Intervention.  For a baby or young child who may have intellectual or developmental disabilities, the Department of Assistive and Rehabilitative Services (DARS) has a program called the Early Childhood Intervention.  Call or Visit: DARS Inquiries Line at 1-800-628-5115 or https://dmzweb.dars.state.tx.us/prd/citysearch to learn more.
3. Ask if reduced or no fee services are available.  Consider public or non-profit hospitals and clinics who offer repayment plans and/or reduced fees for low-income patients.  Some private hospitals offer such reduced fee or no fee services as well.  In fact, some private hospitals are required to offer such services called Hill-Burton Free or Reduced-Cost Care.  In 1946 Congress passed legislation that gave grants and loans for construction to various kinds of health facilities.  Though the program stopped providing funds in 1997, about 150 healthcare facilities nationwide are still required to provide free or low-cost care. To locate such a facility, follow this link: http://www.hrsa.gov/gethealthcare/affordable/hillburton/facilities.html .
4. Resources for HIV/AIDS.  The Ryan White HIV/AIDS Program assists low-income individuals diagnosed with HIV/AIDS who do not have health insurance.  Assistance includes healthcare and some other services.  To learn more, visit: http://hab.hrsa.gov/gethelp/index.html
5. Get to know a social worker.  Hospitals, nursing homes, agencies like MHMRA, all have social workers who navigate the system of healthcare, insurance, public benefits, and placement.  Finding a social worker at a facility near you (ideally, one that provides care for your loved one) can be a valuable asset as a care provider.
6. Find a home health agency. Sometimes a family member or loved one requires additional treatment or attention beyond what is offered at a hospital or out-patient facility.  A home health agency provides healthcare for an on-going injury or illness in the home.  Not every home health agency is made a like.  The Centers for Medicare and Medicaid Services (CMS) has developed a checklist to help in the selection of a home health agency: https://www.medicare.gov/what-medicare-covers/home-health-care/Home%20Health%20Agency%20Checklist.pdf.
7. Ensure you have legal authority.  A care provider should always ensure he or she has the legal authority either by the patient, by law, or by a properly drafted and executed directive by the patient or court of appropriate legal authority to make decisions.
8. Create a care plan.  A care plan is a living document that encapsulates the life of your loved one including items like a list of medical providers, statements of the preferences and desires of your loved one, a calender of renewal deadlines and re-certification periods, and copies of relevant advanced directives and powers of attorney, to name just a few items.  This document should periodically be reviewed to be updated or revised because it changes as you and the person you care for change.  It should assist you and the person who might have to step into your role make decisions and provide care.  The care plan is critically important for a loved one who does not have independent resources or benefits, because eventually, the person may become eligible for benefits or receive resources.  And, assessing how resources may interact with the benefits and vice versa are critical to maintaining eligibility.

Future posts will cover some of these topics in more detail and include other areas helpful to being a care provider for your family or loved one.

This post is the first in a series called "Family as Caregivers."  It is true of so many families today that family members are acting as a caregiver for their young, disabled, and elderly, loved ones.  However, what is also true is that many are not adequately prepared to step into these roles when necessary.  There can be a huge learning curve in stepping into a caregiver or provider role, which may include things like assessing a loved one's level of care, discovering and selecting care providers, discontinuing patterns of unproductive or unhealthy conduct and relationships, creating a care plan, navigating available public benefits, finding funding sources, and establishing or modifying proper legal authority to act on behalf of a loved one.  Indeed, this topic encompasses many components and can be overwhelming; however, by creating a plan and finding community supports and resources, the caregiver or potential caregiver role can be made much more manageable.  

Mr. Henry has completed a seminar presentation series on this topic, which will be available in many venues.  To request Mr. Henry to present this series, or others on estate planning, probate, or incapacity planning, contact the Law Office of John B. Henry, III, Attorney & Counselor at Law.

This blog is designed for general information purposes only.  The information contained on this site should not be construed as legal advice or the creation of an attorney-client relationship. 

For more information, contact John B. Henry, III, Attorney at Law, to discuss your legal needs, and visit us at www.johnhenrylaw.com.