Realistic Expectations Of Long-Term Care

A statement I hear almost weekly is, “I thought Medicare covered assisted living!” If there is one piece of information I can share with anyone who may find themselves in the situation of contemplating options for themselves or a loved one, it is that Medicare does not cover any costs associated with assisted living. Unless Medicaid is a factor, even a skilled nursing facility stay past 10 days (or sooner if Medicare has deemed that a patient has plateaued in therapy) becomes a private pay situation.

I’d suggest taking the opportunity to research and become familiar with resources that are available. Attempting to figure things out while a crisis is ensuing is not ideal. Understanding what options are available and the costs associated before a crisis hits will be invaluable.

The average cost of assisted living in Anne Arundel County starts at about $5,000 per month. There are some assisted living homes (five to eight residents) that can accommodate a budget in the $3,500 to $4,500 range. For some people, even that price point will be hard to afford. Looking outside of Anne Arundel County may be necessary to find a lower price point.

I recommend investigating any resources available that may provide a benefit to help offset the cost. Veterans should learn what programs they are eligible for before they are needed, as there is usually a bit of lag between applying for and having a benefit implemented.

For those with long-term care insurance, learn what your policy covers. It’s good to know details. For example, is there a maximum benefit or an elimination period before coverage begins? Most long-term care policies require the policy holder to have the need of assistance with at least two activities of daily living.

Understanding these requirements is key to having a realistic expectation about utilizing the coverage. Usually, these policies can be used for not just assisted living but also for home care services. Home care is a private pay service that can provide assistance with daily activities, personal care, transportation to appointments, medication reminders, housekeeping, meal preparation and companionship. This option can prolong the ability for someone to stay in their home longer, allowing them to hold off on a move to assisted living. Consult with an insurance agent to learn more about these policies and whether there is still an opportunity to purchase one.

Those without the option of veteran or long-term care benefits can consider consulting with a financial advisor. An advisor can assess your financial situation and help determine a budget. They may also make recommendations for adjusting investments and maximizing retirement accounts. Being aware of your financial means and having the ability to take action in advance of a crisis is preferable to sorting it all out during one.

An estate attorney is also a helpful resource, especially if Medicaid planning is a potential factor. Knowing sooner rather than later if you or a loved one are a potential candidate for Medicaid is recommended. Some folks I talk to assume they will “just get on Medicaid” if need be. This is not necessarily the case as there are eligibility requirements, and even if they are met, it is not an overnight process by any means. This type of attorney is also important when power of attorney and/or advance directives come under consideration.

The Anne Arundel County Department of Aging and Disabilities is a fantastic asset we all can learn from. Among others, there are opportunities such as the subsidy and the community options waiver programs. These allow for lower-income residents to have full or partial cost coverage in assisted living. These options have wait lists, though; it is necessary to apply in advance. Again, it is not ideal to wait to investigate and take advantage of options available.

The future is always unknown, but arming yourself with knowledge and realistic expectations is best. Unfortunately, I encounter many families who have failed to make themselves aware of their own situations, much less that of a parent or other family member. No one wants to become ill or encounter age-related issues that impede our independence, but there is a good chance many of us will. Being prepared with options and information will lessen the stress if and when an illness or life-altering event occurs.

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