Paying for long-term care

In these tough economic times, who wants to think of one more discretionary expense to add to the monthly budget? But, as this piece in the New York Times discusses, future long-term care costs for an individual could exceed $1 Million!

Long-term care insurance has been around for several decades, yet many people roll the dice as to whether they purchase it or not. Besides the statistics of one's chances of needed expensive nursing home care, the article also looks at the reasons we often choose not to obtain such protection.

While some excuses for not having insurance are incorrect or somewhat inaccurate (e.g, thinking Medicare will pay (which it doesn't), expecting our own savings to be sufficient, and counting on family members to care for us), "there is also a great deal of justified skeptism about the long-term care insurance industy."

On that skeptical side, some insurance companies are looking at raising their premiums by double-digit increases.

Wisconsin's Office of the Commissioner of Insurance (OCI) has a helpful guide on its website. Furthermore, Wisconsin is one of a number of states that offers Long-Term Care Insurance Partnership program to encourage the purchase of long-term care insurance by offering greater asset limits for Medicaid coverage. Search the OCI website for more information on all related topics.

Health care reform explained

In all the swirl of comments and controversy, the New York Times offered this primer on the health care proposals in Washington. It highlights that there are still several bills under consideration, that the outrageous claims of some are unfounded, and various interests will need to compromise (meaning, the President, Congress, doctors, insurers, your grandmother will not get all they had hoped for).

Obviously, this topic is still a moving target, so stay engaged in the news for how healthcare reform will unfold.

The "fear" of government sponsored health care

Recently on Slate.com, "Scaring Grandma" relayed the speed bump in the Obama health care plan--reducing Medicare expenses, which some interpret to mean denying end of life care.

Here's an excerpt:

Many senior citizens are concerned that health care reform would mean cuts to Medicare. That much was clear at a town-hall meeting hosted Tuesday by the American Association of Retired Persons at which Obama fielded questions from seniors who don't want to give up their benefits.

But one question stood out. It addressed what the host from the AARP called the "infamous" Page 425 of the House health care bill. (Read the bill here.) "I have been told there is a clause in there that everyone that's Medicare age will be visited and told to decide how they wish to die," said Mary from North Carolina. "This bothers me greatly, and I'd like for you to promise me that this is not in this bill." The host elaborated: "As I read the bill, it's saying that Medicare will, for the first time, cover consultation about end-of-life care, and that they will not pay for such a consultation more than once every five years. This is being read as saying every five years you'll be told how you can die."

In a more balanced description of the options before Congress, the National Academy of Elder Law Attorneys reports:

The Secretary of HHS has sent a comprehensive report to Congress entitled “Advance Directives and Advance Care Planning.” The report, requested by Congress in 2006, focuses on (1) the best ways to promote the use of advance directives and advance care planning among competent adults as a way to specify their wishes about end-of-life care; and (2) addressing the needs of persons with disabilities with respect to advance directives. You can link to the report at: http://aspe.hhs.gov/daltcp/reports/2008/ADCongRpt.htm. It includes an excellent literature review on every aspect of advance care planning, analyses of key ethical and legal issues, and a discussion of opportunities to enhance the effectiveness of advance care planning and advance directives. The report is particularly timely as health care reform is in the public policy forefront, and several bills are pending on the Hill regarding a dvance care planning and improving care near the end of life.

In addition to the full report, a background report is available at ttp://aspe.hhs.gov/daltcp/reports/2007/adacplpi.htm.

Happy reading!

Congress takes on long-term care insurance

The New York Times' blog, "The New Old Age, " posted this entry about the current congressional discussion about long-term care insurance. The issue has many facets, including consumer protection, financial soundness, and the variables of the marketplace.

Consumers must balance premium affordability with the types of services they may want, the daily benefit amount, the length of coverage and other options, such as inflation protection. But personal needs and the marketplace can change in the decades between purchasing and using a policy, [the executive vice president of the Kaiser Family Foundation] said.

The uncertainty of guessing what care will be needed in the future and at what cost is a huge challenge for consumers. Nevertheless, Congress and insurance companies are trying to work together to provide options and incentives, given the growing pressures on the Medicaid system and Medicaid's tough asset spend-down requirements.

Nursing home "five star" rating system

Medicare has launched a new online system for rating and comparing nursing homes. Besides the various tools to explore nursing home information, the site also provides some basic information on alternatives to nursing home care.

In a charmingly colloquially phrased opinion piece, the Honolulu Advertiser summarizes the new system this way:

The long-term care of Hawai'i's kupuna [honored elders] will become a bigger issue in the future, as more of the population gets older and in need of more intensive care.

Certainly, efforts to put more state and federal funding into at-home care — so-called "aging in place" — should be a priority. It can be more cost-effective, more comfortable for the kupuna and help open up nursing home beds for those who really need that higher level of care.

Making sure Hawai'i's nursing homes offer the highest quality care possible is a joint responsibility — the government, the industry and consumers all have a role to play.

The rating system, while not perfect, provides a useful measure of how we're doing and more important, how we can improve.

A recent report (pdf) on effectiveness of programs for helping low-income Wisconsin residents to live at home or in facilities than nursing homes shows that alternatives cost less than typical nursing home care. The next big goal is to expand the programs across the state so that the alternatives are available to all who want them.

(Photo by laughlin; used by permission.)

How much can and should children pay for their elderly parents' care?

Jane Gross, the blogger of the amazing New York Times' "The New Old Age," shares her experience and other good information about adult children's responsibilities for their parents' long-term care. Some thirty states even make adult children legally responsible for such support.

Here is an excerpt from Adult Children, Aging Parents and the Law:

At the end of my mother’s life, for six months, a year at most, Medicaid paid for her care in a nursing home. She was broke by then, after living on a pittance since she was widowed at 58, using the proceeds from her house to pay for six years of assisted living and part of her nursing home stay and never seeing a penny from a long-term care insurance policy that cost a bundle but covered none of what she needed. She had given my brother and me no up-front money to hasten her eligibility for Medicaid and died with $26 to her name and nothing to leave to her children. The good news was we didn’t even have to put her will in probate.

. . .

I sometimes wondered why adult children weren’t legally responsible for their parents’ financial support, assuming they had money in the bank. Don’t get me wrong; I didn’t want to pay for her $14,000-a-month (yes, $14,000) nursing home bill. But I could have, if truth be told, at least for a while.

(Photo by makelessnoise; used by permission.)

Assisted living options

The New York Times' excellent series, "The New Old Age," continues with 10 Things to Know About Assisted Living. The general information is quite good about what to consider in looking at assisted living arrangements. Another general web resource for all types of elder residential options is "A Place for Mom," which is a national referral service.

However, remember that although nursing homes are heavily regulated on the federal and state levels, assisted living apartments and homes are regulated much less, and only on the state level. So, whether looking at the services a facility offers, the medical options, or any other contract terms for assisted living, consult local or state resources too. For example, in Wisconsin, Community Based Residential Facilities (CBRFs, for short) can offer home-like settings for many types of needs, (dementia/memory care, for one), but CBRFs can only offer limited medical care. As a starter on Wisconsin resources, see the Department of Health Services website section on CBRF resources.

For more information on a national level, check out the Assisted Living Consumer Alliance.

(Photo by jonrawlinson; used by permission.)

A new link: Coalition of Wisconsin Aging Groups

"The Coalition of Wisconsin Aging Groups, a grassroots membership organization directed by seniors in Wisconsin, pursues justice and quality of life for people of all ages through legal and legislative advocacy, education and leadership development." (Mission statement of the coalition.)

CWAG's website has abundant resources for elders, including information on legal services and resources. They also have newsletters and other publications in a resources section.

Needless to say, the organization and its website are a valuable resource to the community of elders, their families, and their advocates. I have added the link to the CWAG website to my list of sites on the right.

New web resource about Medicare

I have been waiting for the right topic to link to the New York Times excellent series on aging, and here it is! Although this article is not as personalized as some others (check out all the topics at the series webpage), it is a good introduction to the new Medicare website for caregivers.

For the over-65 age group, Medicare pays for certain health care services, mostly hospital and doctor care, but does NOT pay for long-term care. As the article quotes Kerry Weems, the acting administrator of the federal Centers for Medicare and Medicaid Services, “We should be shouting from the rooftops, as often as we can, that Medicare does not have a long-term care benefit.” (However, in some cases, Medicare will pay for short-term nursing home care if it follows a hospitalization and is recuperative.)

Only after a person exhausts nearly all financial resources, will the federal Medicaid program (for those with low incomes and low assets) cover nursing home care. Even then, Medicaid is biases to nursing home care and typically does not cover other types of care, such as home health care or assisted living arrangements. The Medicaid rules are complicated and vary somewhat from state to state and differ for single persons and married persons, so consultation with an elder law attorney is strongly advised for any planning or qualification questions.