Lengthy-term care: entry and affordability

Our last article discussed the urgent need for long-term care that many older Americans and their families face. Navigating the maze of services is awkward and daunting. The industry is very fragmented. There are nursing homes run by corporations, home health franchises, local nonprofits, freelance caretakers, and government agencies, to name a few of the players. Where do you even start?

We recommend that you speak to your family doctor or another trusted healthcare provider first. They assess your health, hear your wishes, formulate a “chronic care plan” and provide the materials to qualify for services.

Sometimes an acute illness or injury, such as a stroke or fall, can alter your functionality and your health outlook. If you are admitted to a hospital or rehab facility, see a “discharge planner”, “care coordinator” or “case manager”. They are the professionals at navigating the complex system of support services.

Before:Health questions: Long-term care: what are the options? (Part 1)

The No Wrong Door System is a network of local organizations with trained advisors who will accompany you on your way to long-term care. They are often referred to as the Aging and Disability Resource Center, Area Agency on Aging, or Center for Independent Living. Check the National Eldercare Locator (1-800-677-1116 and [email protected]). The Illinois State Department on Aging has a hotline (1-800-252-8966 or 217-524-6911) and a web portal that can also connect you with local authorities. Once you’ve got your foot in the door, a care coordinator will meet you to determine the appropriate services, determine if you are eligible for government assistance, and help you apply.

The next question is how do you pay for the care? Long-term care is not covered by commercial health insurance or Medicare, which are only paid for short-term nursing home stays after surgery or hospitalization.

Long-term care can be expensive. On average, a full-time domestic helper costs $ 52,910 per year. A private room in a nursing home costs $ 105,850 a year, an astonishing 245% of the median household income of a 65-year-old couple.

Medicaid pays close to half of all long-term care costs in this country. The qualification is based solely on income and assets. You must spend your savings including retirement and retirement accounts before Medicaid kicks in. Transferring assets to children or anyone else within five years of the need for care will result in a penalty. Hence, long-term financial planning is vital if the government is to create a chip in.

If you are a veteran, the VA offers home and home health benefits. The VA even operates many nursing homes across the country, but it’s not entirely free. Depending on your income and service-related disability, you may have to share some of the cost. Apply in person at your local VA medical center or online.

Some states (unfortunately not Illinois) sponsor Comprehensive Elderly Care Programs (PACE). It is a one-stop shop for the medical, physical, and social needs of the elderly. A local agency manages the services and coordinates various providers with the aim of keeping the seniors at home for as long as possible. The program is free to Medicaid recipients. Those who use Medicare pay a monthly premium, but there is no additional co-payment, deductible, or other cost-sharing.

Long-term care insurance is a wonderful concept, but in reality, payments from such plans make up only 8% of all care costs. Insurance companies are abandoning the product because the high claims frequency reduces profitability. Oddly enough, profits rebounded in 2020 when their payout declined due to the high mortality rate among nursing home residents. The premiums and the rigor of the underwriting are increasing. More than a third of people who apply for coverage are turned down because of pre-existing health problems. Only 43 out of 1,000 people aged 45 and over are in need of care. A more popular option, often offered by employers at a discounted group rate, is combined life and long-term care insurance, which allows you to get a portion of the death benefit while you are alive.

After all, the best way to save for long-term care may be to avoid it all together. Stay healthy, take care of your body and mind, and strive to live independently for as long as possible.

Qing Yang and Kevin Parker are married and live in Springfield. Dr. Yang received her medical degree from Yale University School of Medicine and completed residency training at Massachusetts General Hospital. She is an anesthetist at HSHS Medical Group. Parker has helped formulate and administer public order with various city and state governments across the country. Today he is Group Chief Information Officer for Education at the Illinois Department of Innovation and Technology. This column is not a substitute for professional medical advice, diagnosis or treatment. The opinions are those of the authors and do not reflect the views of their employers.

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