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Caregiving

A Guide to Finding Long-Term Care for Your Loved One

What to know as you consider the many options


Part of the Transforming Life as We Age Special Report

If you are one of the many people in the U.S. faced with helping a parent or another loved one find long-term care, then you are probably grappling with a lot of questions. Among them: How can I bring this up in a way that won’t upset him? How is she, or how are we, going to pay for this? What type of living situation is best? Fortunately, there are a lot of resources and experts who can offer ideas for solutions to these problems, and Next Avenue has tapped many of them for stories. This guide to long-term care planning includes links to several of our articles on this topic. We hope it gives you food for thought and helps you along your way to making sure your loved one finds the ideal long-term care solution for him or her.

 

Whether you’ve noticed your loved one struggling with some of the activities of daily living or you want to be proactive and make a plan before care is needed, it’s wise to have a talk with your loved one about the topic.

Why It’s Necessary to Talk About Long-Term Care

Many people haven’t formulated plans to deal with the help that they may need as they age – it’s just not something most of us want to think about. So, it’s very likely that your parent or loved one hasn’t planned for long-term care, a category of nonmedical care that encompasses a person’s daily care needs.

Many people don’t consider getting long-term care insurance before they need it, partly because the coverage is costly, but also because they may not think it’s necessary. Although surveys have shown that two-thirds of people believe government programs will cover some or all of the costs of long-term care, this isn’t true in most cases. That’s why talking to your loved one about options is important.

Because it’s a tough subject to bring up, you might want to think of a good angle. For example, if your parents are private or your family dynamic is such that it’s difficult to talk about very personal things, try mentioning that you read an article about long-term care needs. Another idea: Share details of your friend’s recent experience talking about the subject with her parents. To break the ice, consider showing your parents this Next Avenue video featuring families who hadn’t previously considered their long-term care options.

Understanding Long-Term Care Services

Your loved one may have heard of long-term care, but he or she may not know exactly what it encompasses. The phrase “long-term care” is not synonymous with “long-term care facility.” So you may want to explain you’re not suggesting moving into a nursing home or an assisted-living community, but “aging in place” perhaps with home care. Let your parents know that there many kinds of long-term care, including the possibility of staying in their current home and contracting with a home-care provider.

Whether it’s in-home care or in a facility, these are the most common services that long-term care providers can provide:

  • Bathing
  • Dressing
  • Using the toilet
  • Mobility
  • Managing care related to incontinence
  • Meals

Some people also need long-term care providers to help them take their medications, shop for groceries, clean up after meals, do housework, pay bills or manage their money.

Once your loved one realizes what long-term care services are, it can help you work together to formulate a plan based on the appropriate needs, preferences and financial situation.

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Many people have to pay out-of-pocket for long-term care. Unless money is no object for your loved one, these options could make the costs more manageable:

Long-Term Care Insurance

If your loved one is in his or her 70s, 80s or beyond, it’s almost certainly too late for him or her to purchase long-term care insurance. But even people who thought ahead and purchased a policy for themselves may have to foot the bill for certain costs.

For example, your dad’s long-term care insurance may have a lengthy waiting period (called an elimination period), meaning that he will have to pay out of pocket for 30 days or more until the policy begins paying out. And there are usually caps on, or limits to, what’s covered. For instance, a plan may provide coverage for long-term care costs for just two years, or there may be a $200,000 lifetime limit.

If your loved one lives longer than the policy provides for, or if his expenses surpass the limit, he will be responsible for the remainder of costs. Some experts estimate that long-term care insurance only covers 60 to 70 percent of expenses.

Other Options for Coverage

Most older adults wrongly assume that Medicare will cover their long-term care costs. However, Medicare is a fedeal health insurance plan, and long-term care costs are typically non-medical expenses.

Medicaid does pay for some long-term care costs for people over 65. But most people don’t qualify for Medicaid because they have too much money in the bank, so your loved one may not be able to use this as an option. Medicaid rules differ by state, but in most cases, people who have more than $2,000 in assets (not including their home or car) are not eligible.

If your loved one is a veteran, he or she may be eligible for the Aid & Attendance pension benefit from the Department of Veterans Affairs, which can be used to cover some long-term care expenses. This little-known benefit is available to honorably discharged veterans age 65 or older who served during wartime. To qualify, they must have a medically documented need for help with daily activities. Surviving spouses also are eligible. There’s a lengthy application process, but the benefit is worth applying for because it can be used for long-term care at home or in an assisted living facility or nursing home.

A reverse mortgage may be another option. If one of your parents, for example, needs to go into an assisted living facility or nursing home but the other parent will continue living at home, this type of home equity loan may help to cover the cost of the long-term care expenses for the parent who has moved out.

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Your loved one may want to age in place, but this isn’t always possible. He or she may want to move in with you one day, but that may not be an ideal situation either. Here are some other possibilities:

Options for Aging in Place

If your mom, for example, wants to stay in her own home and has the funds to hire long-term care providers to meet all her needs, then you can focus your concerns solely on her health and well-being, rather than her finances.

Some people prefer to hire their own long-term caregivers, rather than leaving things to a home-care agency, which may have high employee turnover. Your loved one may consider hiring a private geriatric care manager to help coordinate a long-term care plan, for aging in place with trusted caregivers.

Those who rely on assistance from Medicaid or Veterans Affairs may worry that they’ll have no choice but to use home care agencies. If your loved one is interested in coordinating his or her own care, it’s possible to put together a person-centered, self-directed long-term care plan. Plans vary by state, but all 50 states have self-directed plans.

Considering Other Locations

Sometimes, it isn’t possible for your loved one to continue living at home, but costs for assisted living facilities and nursing homes can be staggeringly expensive. According to recent data, a one-bedroom unit at an assisted living facility can cost $45,000 per year, and a private room in a nursing home can cost $97,000 annually. If your loved one needs to live in a facility and can afford the expense, that’s one less thing for you to worry about. If he or she qualifies for assistance from Medicaid or Veterans Affairs, those funds can be used to pay for long-term care in assisted living facilities or nursing homes.

Another option that’s considerably less expensive than assisted living facilities or nursing homes is an adult foster home, which is sometimes known as a “group adult care home” or a “board and care home.” This may be an ideal situation for someone who needs long-term care assistance for several activities of daily living. Adult foster homes are typically housed in residential homes with only a handful of older adults, so they often have a more homey feel than large facilities.

As you discuss long-term care options with your loved one, be sure to involve him or her in the decision-making process and make sure he or she feels comfortable with the caregivers and the setting you finally choose.

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By Lisa Fields
Lisa Fields is a writer who covers psychology and health matters as they relate to the workplace. She publishes frequently in WebMD and Reader’s Digest.

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