“About 70 percent of people over age 65 need some type of long-term care during their lifetime. More than 40 percent need care in a nursing home for some period of time,” says the National Institute of Health (NIH). According to the NIH, what is termed long term care (LTC) can actually last for a long time or a short time. Long term care can be delivered in an institutional setting or the home depending on the specific situation and needs of the patient.
LTC has become a very broad term and evolved into a term for the type of care required rather than the time period. A patient might require long term care due to a sudden illness or injury where rehabilitative therapy is required in a long term facility such as a nursing home. On the other hand, the patient might need long term, on-going care due to disease progression such as Alzheimer’s or dementia.
While we usually think of LTC with respect to our elderly population, (about 60% of individuals over age 65 will require services), LTC is also provided to younger individuals (about 40% of those receiving services are between age 18 and 64). As such, we need to start thinking about LTC and its associated supports and insurance sooner than once considered.
In the case of an elderly person, the need for care can be the result of a sudden event such as a fall or stroke or it can develop more gradually. You might notice signs and symptoms of your senior loved one faltering over the course of months or even years. Once you start noticing your loved one might need help, you will want to begin acquainting yourself with various services you may need in the future.
Before it comes to the point where total personal care is required for their activities of daily living (ADLs) like bathing, grooming and dressing, other ancillary services might be necessary. For example, there are transportation services such as Access-A-Ride or meal plans such as Meals on Wheels once the senior is no longer driving or able to shop and cook their own meals. Also, there is adult day care and senior centers to help get them out to socialize and keep active.
Remaining at home means you must make sure the environment is safe and there is enough coverage. This is when elderproofing and emergency response systems in the form of a necklace, bracelet or watch can come in handy should the senior fall or have a catastrophic event while alone.
Even when care does not dictate admission to a facility, the intense demands of caregiving may make paid LTC with a home health aide a necessity. The 2015 AARP study on Caregiving in the US reports that over 40 million Americans provided unpaid care to adults last year with an average of 44.6 hours for spouses or partners. With 1 in 10 of those caregivers being elderly themselves at 75 years or older, it would seem caregiving by a family member alone may be a short term solution.
Institutional care comes in all shapes and sizes. An interesting option for seniors is Continuing Care Retirement Communities (CCRCs). These offer independent housing, assisted living and skilled nursing home care under one roof. Someone may start off living independently, but may graduate into higher level care without a big move. In a CCRC, they will be able to move into different levels of care as they need it. It also enables spouses needing various levels of care to be close to each other.
Each wing of the CCRC comes with different amenities. Those who are more independent will have different psycho-social needs than those who are not and classes, entertainment and meals cater to the diverse segments of residents.
All this sounds interesting, but how do people afford all this?
Aside from personal savings, there is long term care insurance available with a variety of options and various levels of coverage which is less expensive the earlier you sign on. LTC insurance covers care not covered by health insurance, Medicare or Medicaid and protects your savings accounts from becoming depleted by the increasing costs of healthcare. Premiums may be tax deductible, in some cases up to 100%. Having LTC insurance also eliminates the burden to family members who would be providing this care.
Financial planners can help make investments taking into account long time horizons and some recommend taking out a reverse mortgage on your home to fund eldercare. Some life insurance policies will allow for an accelerated death benefit or a home healthcare rider to pay for eldercare with the disbursed sum to be deducted from the eventual payout.
We have all heard of government programs such as Medicare and Medicaid which should be explored in addition to any veteran’s benefits and social security. With nursing home care being so expensive and Medicaid eligibility requirements, there are elder law attorneys, financial planners and geriatric care managers that specialize in spending down assets to take advantage of Medicaid funding.
If we are lucky enough to be blessed with long life, aging is a certainty. The ancient Greek Agesilaus said, “By sowing frugality we reap liberty, a golden harvest.” We need to plant seeds for retirement and declining health long before the day comes. If we put the proper supports in place early enough, those years are sure to be golden.
Anita Kamiel, RN, MPS, is the founder and owner of David York Home Healthcare Agency, licensed by the State of New York. She holds a master’s degree in gerontological administration and is fully acquainted with all factors related to eldercare services and the latest guidelines for seniors. Thirty years ago, she realized the need for affordable, quality home health aide services provided and supervised by caring individuals. You can contact her at 718-376-7755 or at www.davidyorkagency.com. David York Agency is also on Facebook, Twitter, Google+, and LinkedIn.