How do you afford long-term care costs?

This may not be an option or choice for everyone but here is what my mother did.  And it gives our whole family peace of mind.

After a health crisis/scare, Mom recovered and chose to move into independent living in a Continuing Community Retirement Center, located in her community.  This CCRC also has assisted living, nursing home and Alzheimer's center.  If and when she needs to move to the next level of care, no problem.  Her monthly rate is locked in at the rate for independent living.  It is all-inclusive and affordable for her (compared to maintaining her home and bringing services in).  It's been a year now and she is settled, happy, and healthier than she has ever been.  Her income (Social Security, annuities, pensions) cover the cost. 

For those who choose to make the move early (before crisis hits and health declines), CCRC communities can provide a good long-term option.

Don't forget to check out the VA , Aid & Assistance Program.. You may need a professionals help but its worth it.

 What sort of professional helps out with VA and Aid and Assistance?

Call your local VA and the social worker there should be able to help you if you or your spouse was a vet.  There is assistance for nursing home costs for vets or their spouses.  It is not a great amount, but does help with costs and possibly some medical care.

A member of my family is also in a CCRC and absolutely loves it.  She entered independently and still lives so.  She participates in loads of activties and feels great about it.  It also gives us huge peace of mind that if she needs additional care, we know where it will be provided. 

My mother is also in independent living in a CCRC, a wonderful situation for her.  Her  all inclusive rate is very low now but it will increase to the "going rate" for assisted living or nursing care, if and when she needs it.  My goal is to have her investments produce enough income so that, in addition to her Social Security, her total income will pay her monthly fees --- both now and in the future if her fees go up.  I am now looking into an annuity to provide a fixed stream of income, in addition to the income she receives from her other investments.  She was not eligible for long term care insurance when she applied at age 80 and I am looking at an annuity now, as a substitute for the insurance.  WIth this whole scenario, I hope she will not have to spend down her assets at a nursing home, and instead, will spend her income.  This means she will not be eligible for Medicaid.  Does this sound right ?

My mother has been in an assisted living facility since 2006.  She has since moved to the "memory care" floor.  The money she scrimped and saved for plus the money she got after selling her house is paying the expenses.  She has enough for 3 more years.  None of her four children are in a position to pay for the $50,000 plus yearly expense.   Since she can no longer walk, she needs help with everything like bathroom, showering, getting dressed etc.  I believe she receives excellent care but am worried about what will happen in 3 years. 

Contact the Department of Social Services about the ongoing care when your mother's money is at the last 4 months or so. If she is in a facility that ONLY takes private pay (which I suspect) then she will have to be moved to another facility that accepts Medicaid/Medicare.

There are also  excellent church-sponsored facilities in many states that are far less expensive than the egregiously priced private-sector facilities. Have you thought to explore that possibility?

I would even think about looking around NOW to see if there is a facility that is well rated (you can check their ratings online on the state Human resources/DSS nursinghome websites. Most state DSS sites maintain a listing of all complaints against assisted living/ nursing home facilities and their staff/patient ratios, their general reputations, etc). You MAY discover a facility that is equal to her current one at a much lower cost. Yes she will probably have to be moved, but that is probably unavoidable if the facility where she is now refuses to accept medicaid when her assets are exhausted.  There are ALSO inhouse programs (assistance bathing, cleaning, etc)  within Social Services that offer assistance that are not based on income or assets but rather Community Grants for Older Adults. It couldn't hurt to contact Social Services and talk to a Social Worker about ALL the programs available in your area. That is your right.

We can only hope that the healthcare programs that are now being buffeted around in Congress will be brought into the realm of reality so that all healthcare is considered a HUMAN RIGHT.

Good luck to you!

Sounds right to me. I congratulate you on being on top of it. AND for being in a position that allows you to retain the assets. you deserve them and it is what your mother would want.

By the way, if you purchase a home in her name with her assets with the intention of her returning there "someday" then the house will be there after the liquid assets are exhausted AND she would still be eliigible for medicaid in many states. The state would then consider her eligible for medicaid and they would not take the house but rather would bill the estate for what was paid on her behalf, which might or MIGHT NOT be the entire house value at the time of her demise. Also, if the house was put in your name only, after a certain period of time, she would be considered qualified for medicaid. There is a 3-year (I think)  "asset transfer" restriction here in NC, and I suppose that varies from state to state. That means that if that were to be done three years BEFORE your mother applied for medicaid, she would be disqualified  based on asset transfer for that next 3 years, (its sort of like entering a "spend down" period wherein the value of the asset (house) would be depreciated by the cost of the ongoing care the state was NOT required to pay. . In other words, if the house was worth $200000, and the cost of a facility was $4000 monthly, the value of the transferred asset would be decreased by $48,000 a year until it was zeroed out. At that rate, the house would not be able to be considered an attachable asset  either 3 years (if that is, in fact, the asset transferdisqualification period) OR at ANY rate, 4 years and 2 months (equal to $200000 if my math is right) after she filed for medicaid and was considered ineligible/disqualified for that period specified by law due to asset transfer).

If the house was placed in your name only, it would no longer be considered an asset after the disqualification period expired.  She would at that time become eligible for medicaid if and when her liquid assets were at the point of depletion.

If the house was put in both your names, only HALF the value would be attachable after the disqualification due to asset transfer period expired. And maybe not even then.

Talk to an estate attorney if you can afford to and sk how your state is set up.

Confusing because that's the way the government wants it to be. they want everone to sell everything, never transfer ANY assets, use up all the money and THEN apply for medicaid. And they plan on the old folks dying before they start getting any assistance from the government. How sad.

It's only those elderly people who have nothing to lose  --for whatever reason, low wages, never having opportunity, etc---or those who have sadly exhausted all their assets that are getting medicaid now.

How unfair to all those who worked all their lives to have some sort of legacy to leave to their children and  to the children who care for them as long as they can, only to have to give what is left  to the government when the demands of their  infirmity render their children  helpless to continue caring for them and medicaid comes in for "payback".

The VERY rich use the MANY asset transfer loopholes regularly because they can afford slick attorneys. It's only the lower income folks who just hand over everything without a fight.

Vote in favor of the new Healthcare Programs and a (reasonable) inheritance asset exclusion law to come into being.

The rich can take care of themselves, IMHO. >).

Please keep in mind I am NOT an attorney, I WAS an eligibility specialist many years ago and all this is based on MY personal research. I am not offering ADVICE. Just telling you what it is like here where I live ;) and how is MAY be where YOU live.

Just remember to ASK THE RIGHT, SPECIFIC QUESTIONS of the DSS and MAKE them tell you what the law is in your state regarding these RIGHTS.

If I may ask, what happens to her assets when she passes on?

Where does your mother live? It sounds like a wonderful option.

What state do you live in? I may move there...lol

Thanks so much.  You had a lot of good suggestions and I will look into them.

To her 4 children and 11 grandchildren.

I really don't know what is right.  I just think it is unfair that when she runs out of money, she will have to move.  The insurance compainies CEO's are getting mego billions in profits off the backs of hard working people.  And our representatives in Congress are getting mega millions in donations for campaigns.   Imagine what wonderful things could be paid for with this money.

I totally understand. However, those who haven't annuities or the resources your Mom has will have already liquidated their assets and there will be no inheritance at all for those caregivers.

I  heartily agree about the Insurance CEOs and the fat cat arrangements they have made thanks to millions of lobbying dollars paid to our illustrious Congressmen and women.

That's why I think lobbying/political contributions over a certain amount---no matter how they try to hide them--should be STRICTLY  audited and severely limited.

. Our entire political structure is so whacked that "normal" non-elite Americans are suffering on all levels. And the seniors such as our parents are the ones who are sacrificing much more than others.

I also think for every year of care that children give to their parents before medicaid becomes a factor the amount the government did NOT have to pay on the patient's behalf should be discounted from assets regardless of the time of application and that medicaid should be available to all with that type of "spenddown" against what the govt can reclaim. I also think that ALL medical care facilities should be required to accept Medicare but then the rich wouldn't have any palce to put their parents. And, of course, that is interfering with "free market" commerce. I intend to support any and all programs/bills that bring a national heathcare system into being.

Take some solace in the fact that your mother may be past the point of actually registering the change as impacting her when the time comes. I don't know her condition, but it may be a blessing when that occurs.

That is a really good question, I work for a nationwide caregiver network and this is definitely our number one question. We are writing a multi-series set of blog posts about different payment ideas: VA benefits Reverse Mortgages Medicare Long Term Care Insurance etc.

If you are interested, I hope that you will check out http://www.rightathome.net/seniorhomecare to read more in-depth on each of the topics.

Good Luck, Bill

Oh, boy! I really hate reading about political issues on a site that I just discovered and am enjoying immensely. Normally, I don't follow or respond to political comments but I MUST caution any of you in thinking that a "national" healthcare system will do anything but lower the quality of care as it has in ALL such programs in other countries. Healthcare reform is necessary but getting ANOTHER huge, expensive bureacracy between us and our healthcare will be a disaster! I beg you to stick to caregiving issues and stop waving the political banners.

I am so sorry I offended you. So how do you pay for long term health care?

We had the same problem. My mother had a tumor removed and was diagnosed with mild dementia. They said she couldn't live along and they were right. For six months I hired people to come to her home, which ended up costing about $6700. After awhile, we ran out of money. I even drained my 401K account because I was raised to take care of family. After all the money was gone, we looked into assisted living and were told she wouldn't qualify for three more months. We literally had no money left. I spoke to an elder attorney, who for a few hundred dollars, looked into Medicaid and found our Social Service department was using the wrong formula to determine mom's qualifications. There have been many changes to the law in the past few years, but even people who work for the government cannot keep up wih the changes, mostly because of work overload. This guy saved our life and helped mom so much. She has been in assisted living since July. At first she did not like it, but eventually she began to feel secure there and the routine and activities were good for her. Now we pick her up on weekends and she's ready to go back by suppertime. Telling her she was moving from the home she shared with my late father was devestating for me. But, within two or three weeks, she was content. There are moments she is aggravated, but that was true when she was at home with care-takers. My advice is, don't just settle for what Social Services says, research it, ask for their manual regaring assisted living or if you can, hire an elder attorney. A few hundred dollars can pay off in thousands. Just because you move a loved one to an assisted living home doesn't mean you stop interacting. Visit regularly, take her to your home to visit, to a restauarnt and she will still feel alive. I miss the old days, but that doesn't change the reality of today. I got so sick about the money situation, I was put on four medications, which is ridiculous. Research the homes you are considering and more importantly ask the families of those who are already there who the place is. I was lucky. Ours is a caring place with caring employees. Good luck to you. I can't wait until research finds a cure for Alzheimer's, but I'm sure it will not be during my mother's lifetime. A daughter who loves her mother.

I appreciate the suggestion of using an elder care attorney, which I need to do. I work full-time and my 77 year old husband has so far been able to stay at home alone during the day. He was not a veteran and has no long-term health care insurance. I am told that Medical (Medicare in California) only pays for skilled nursing centers (nursing homes) and I cannot afford assisted living, and even in-home care will be a stretch for me. Any suggestions?

Here is some information about the Aid and Attendance benefit for people who served in the military during war time. It is not the same thing as a war wound payment. It's for people who served and who are low on money. I got this from a website. You can find these websites online by using a search...

Aid and Attendance Pension Benefit "Aid and Attendance" is a commonly used term for a benefit that may be available to veterans as part of the VA's disability pension, or to the surviving spouse of a veteran as part of the VA's death pension. "Aid and Attendance" refers to the fact that for this particular pension benefit, the claimant must demonstrate a regular need for the aid and attendance of a caregiver or the need to live in a protected environment because of physical or mental impairment. If the veteran does not require aid and attendance, but has a low household income, they may be eligible for a base pension of a lesser dollar amount.

For 2009 the maximum annual benefit for those qualifying for the Aid & Attendance level of pension is:

Surviving Spouse of a Veteran: $12,681 Veteran with no Spouse or dependent children: $19,736 A married Veteran where the Veteran requires care: $23,396 If the Veteran is healthy, but their Spouse requires care, then the Veteran qualifies for a regular pension only: $15,493 Compensation Income Versus Pension Income As stated previously, the Aid and Attendance benefit is part of the VA's pension program and should not be confused with the VA's compensation program. Compensation is a certain amount of monthly income awarded to a veteran to compensate for an injury or illness incurred in the service. This injury or illness is referred to as service-connected disability. The amount of compensation income that a veteran will receive is based on what the VA determines to be the veteran's percentage of disability. Compensation income is tax-free and there is generally no income or asset test for eligibility.

The Pension benefit is a monthly income for disabled or older veterans who have a low income. Pension is for veterans who served during a period of war and who may have disabilities that are not connected to their active-duty service. Unlike Compensation, Pension is based on the veteran's financial picture including household income, as well as assets. When determining eligibility, the claimant's income can be adjusted for un-reimbursed medical expenses. If the veteran's net income after un-reimbursed medical expenses exceeds the Pension amount, then there is no award.

While there is also an asset test to qualify for Pension, the claimant may implement a financial and/or estate plan before applying in order to effectively reduce net worth.

Veterans can apply for both Compensation and Pension claims on the same form and VA will consider paying either benefit. If, however, a claimant is awarded both benefits, the claimant can only receive one of them. Generally, if the claimant is dealing with the cost of home care, assisted living or nursing home care, the Pension benefit will most likely result in more income.

There are also death benefit variations of both the Compensation and the Pension program available for surviving spouses or dependent children.

You might consider bartering room and board for cargiving...just a thought.