The greatest financial risk we face today
is the cost associated with Long Term Care.
People have differing ideas of what Long-Term Care is. What is your definition of Long-Term Care?
Picking up after your spouse the rest of your life. Your 40 year old son still living with you. Babysitting your 10 grand-kids. Care received when you are unable to do the regular activities of daily living or have a severe cognitive impairment.
Though A, B and C may all be a part of our reality, letter D is the correct definition for Long-Term Care.
To better understand long-term care, think of the activities that you performed when you woke up this morning. You probably:
- Climbed out of bed
- Walked to the bathroom
- Used the toilet
- Used the bath or shower
- Got dressed
- Ate breakfast
While healthy, it is easy to take for granted these activities of daily living. Once stricken with a degenerative condition (stroke, Alzheimer's, etc.), these can become impossible without assistance.
Long-Term Care:
Is a broad range of medical and non-medical services provided over a prolonged period of time. Focuses on coping with reduced level of functioning rather than intending to cure. Provides assistance or supervision with the Activities of Daily Living (ADLs): Eating, dressing, bathing, transferring, toileting, continence. Provides supervision or assistance needed because of Severe Cognitive Impairment.
The purpose of this assistance is to minimize or compensate for an individual's loss of functioning.
Long-term care includes the same type of care that a parent provides for a new baby.
MYTH: It's only for older folks.
Fact: 40% of those currently receiving long-term care are ages 18 - 64.
A few of the younger recipients of long-term care services include
Christopher Reeve ˜ As a result of a tragic equestrian accident, the man who portrayed Superman became a quadriplegic needing 24-hour daily assistance. Charlie Weidemeyer ˜ One of our island sons contracted Lou Gehrig's Disease (ALS) and has been wheelchair-bound for more than 25 years.
With the advances of medical science, surviving an accident or illness is far more likely, however our quality of life may be severely impaired.
Fact: LTC is for older folks, too.
Of course, LTC is often needed by those 65 years of age and up. 60% of those now receiving such care are seniors. It's a fact of life -- we're living longer.
The elderly population is growing and as it does the need for long-term care increases as well. Baby boomers, who have contributed to this growth, have already begun receiving "senior discounts" in some establishments! The oldest of the more than 76 million baby boomers (those born between 1946 and 1964) turn 58 in 2004.
Three words characterize what is important to many of us:
- Independence
- Choice
- Control
Just because our health may change, our desire to maintain our independence, the ability to choose and to have control over our own situation does not diminish.
We want to be able to choose:
- Where we receive care.
- The quality of the care we receive.
- Who provides the care.
When people think of long-term care, usually skilled nursing facilities come to mind, however there are a variety of settings in which care can be received.
Skilled Nursing Facilities
Both skilled and custodial care are provided in these state licensed facilities. Skilled care would include physical, speech or occupational therapy provided by a therapist, a registered nurse or a medical social worker. Custodial care is assistance with basic functions such as bathing and dressing.
Assisted Living Communities
These communities are designed for those who need help with basic functions. Services include meals, assistance with personal care, housekeeping and laundry, and help with medications.
Adult Care
Unlike Skilled Nursing Facilities and Assisted Living Communities that provide 24 hour per day services, Adult (Day) Care Centers are open during regular business hours. They allow caregivers who have careers to bring their loved ones to the Center for care during the day. These Adult Care Centers offer a range of services including recreational, educational, social activities and some health services.
Home Care
Most people prefer to "age in place", in other words, to receive care at home. There are two types of Home Care.
Home Health Care: Licensed nursing personnel from a home health care provider, offer services to fulfill the plan of care prescribed by a physician. The services are often part-time or intermittent and received in the comfort of the individual's own home. Home Care: This type of care is custodial and can be provided by non-licensed individuals. Assistance is given with the activities of daily living (such as bathing and dressing) as well as help with housekeeping, laundry and meal preparation.
The cost of Long-Term Care depends on where care is received and the type of care needed.
The rates for Nursing Homes on Oahu vary by facility. The average in 2002 was approximately $188 to $200 per day for a semi-private room.
According to a study done in May of 2002, the cost for Assisted Living in Hawaii averaged $3,250 per month.
In-Home Care costs are dependent on the type of services provided and ranged between $19 and $30 per hour in 2002.
Personal Savings and Other Financial Assets
Long-Term Care services are expensive. Accumulating the amount that will be needed takes saving large sums over many years. For most people, it is not feasible. Few have sufficient assets. Then there is the risk that nothing may be left for the surviving spouse.
For those who do have sizeable assets, the question is whether you want to take the gamble of possibly having a liability with no fixed limit. Accumulated assets are often earmarked for heirs or charities, rather than paying the costs of long-term care.
Help From Family Members
In the past, our families were larger and often remained geographically close together. This plus the fact that our life spans were shorter, allowed for more family assistance when the need arose. These days our families are smaller and often our children relocate away from Hawaii. In most families who do remain close by, both husband and wife work. Family members are often not available to provide needed care. Those who are available find that care-giving puts a strain on the family and most family budgets.
Medicare
Medicare focuses on medical care, oriented to recovery. Long-Term Care benefits are very limited and restrictive. Medicare benefits are available when following a stay in the hospital of at least three consecutive days and then for skilled nursing and rehabilitative care only. The maximum benefit period for each illness is 100 days.
| Days |
Medicare Pays for Long Term Care |
| 1-20 |
All |
| 21-100 |
All but a substantial copayment which the patient assumes |
| 101+ |
Nothing |
Private insurance enhancements to Medicare and private health insurance
Neither of the above was designed to pay LTC bills.
Medicaid
Medicaid provides for health care needs for the poor. In order to qualify for Medicaid funds an individual must become impoverished.
Many facilities do not accept Medicaid recipients. Those that do may not provide the choices or quality of care we desire.
- To avoid being a burden to family.
- To remain at home and to be independent.
- To protect my assets.
- To be able to "age in place" with dignity.
- To have peace of mind.
- To choose my caregiver and the quality of care I receive.
Actually, ALL are important. All are excellent reasons to plan ahead. What matters is what is most important to you!
Long-Term Care Insurance (also known as "Nursing Home Avoidance Insurance")
Benefits of planning ahead by owning insurance include:
A plan is in place so that long-term care needs will be met. Savings and assets will be preserved. Premiums are modest and can be budgeted for (rather than cost of the care itself). Protection is tailored to the needs of the individual. Choices and range of care options will be available. Money will be there to pay for high quality care.
Myth: LTC Insurance is not affordable
Fact: LTC Insurance can be customized to fit your needs, your family and your budget.
www.hah.org
Healthcare Association of Hawaii
Click on "Long Term Care" for statistics related to Hawaii specifically and how the needs here compare to the mainland. www.alfa.org
Assisted Living Federation of America
Click on "Consumers"; Click on "Consumer Checklist"; Checklist of important services, amenities and accommodations in assisted living communities. www.ncal.org
National Center for Assisted Living
Consumer information on long-term care; Assisted living information; A consumer's guide to assisted living facilities; And more www.nahc.org
National Association for Home Care
Click on "Consumers" for guidelines on choosing a home care provider. www2.state.hi.us/eao
Executive Office on Aging ˜ State of Hawaii www.medicare.gov
Medicare
Search box: nursing home; For advice on selecting a nursing home.
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