Wednesday, April 24, 2013

Financial Planning for Long-Term Care

Decisions about long-term care can be emotional and complex for everyone involved. Financial worries are a common source of stress when planning for the care of a family member or when planning for your own.

Knowing your options can help to provide peace of mind when it’s time to make your final decision.

Government Programs Can Assist with Costs

If you cannot afford long-term care, two government health insurance programs are available to provide assistance.

Medicare is a federal program available to persons over the age of 65 or to younger persons with disabilities. To learn if you’re eligible, call 1-800-772-1213 or visit your social security office.

Medicaid is a state program for persons who cannot afford medical care. You may qualify based on income, if you receive social security, or if you have medical bills that you cannot afford to pay, regardless of your income.

If you're applying based on income, income requirements vary depending on the number of persons in your household. For example, if you live alone and are over the age of 65, your income must be $792 or less in order to qualify for Medicaid.

For more information about Medicaid eligibility in Erie County, call (716) 858-8000.

Services Covered by Medicare and Medicaid

Medicare will cover care in a nursing home, where care is provided by registered nurses, only if it is medically necessary. The amount covered by Medicare depends on your length of stay:
  • First 21 days: all costs are covered by Medicare
  • 21 days-100 days: you pay up to $144.50 each day
  • 100+ days: you pay for all costs
Medicare does not pay for custodial care, which is help with daily living activities, such as bathing, dressing or eating.

Medicaid is more comprehensive and pays for long-term nursing home care, assistance with activities of daily living and for some services at home and in the community.

Medicaid requires that you use your income (except for $50 per month) to pay for your long-term care, and Medicaid will pay the balance.

How to Protect Your Assets

Most insurance plans do not cover long-term care, but you can buy long-term care insurance to help with the costs.

Depending on the plan you choose, long-term care insurance should cover the average cost of home care, assisted living or skilled nursing. Plans have a maximum dollar amount that they will cover each day and overall.

Long-term care insurance is best for people who have assets to protect, such as retirement savings and investment plans.

The American Association for Long-term Care Insurance recommends applying for insurance in your mid-50s, when you are less likely to have an existing health condition.

What’s Included in Nursing Home Costs

Basic services included in the cost of your stay are:
  • Room and board
  • Meals
  • Nursing care
  • Pharmacy and diagnostic services
  • Use of equipment and medical supplies such as syringes, needles and dressings
  • Fresh bed linen, which should be changed at least twice a week
  • Hospital gowns, if needed
  • Laundry service
  • Medicine cabinet supplies, including nonprescription medications and personal hygiene items, such as hair care items, toothpaste and skin care items
  • Assistance with daily living as needed, including bathing, feeding and moving from place to place
  • Equipment such as walkers and wheelchairs
  • Social and recreational activities
  • Social services, if needed
  • Optician and optometrist services
Additional medical services depend on the facility. Some are included in the daily cost, while others require an additional fee.

If you or your loved one has any special needs, ask the nursing home if those services are included in the overall cost.

Affordable Alternatives to Nursing Home Care

The national average for a semi-private room in a nursing home is $205 a day. Monthly, the cost can reach over $10,000.

However, for persons needing long-term care, nursing homes aren’t the only option. Alternatives include:

Home Care

Home Care services allow you to live at home and receive healthcare and social services at your place of residence. Depending on your needs, a home health aide may visit your home daily or a few times per week.

Nationally, a home health aide is paid an average of $21 an hour, according to the National Clearinghouse for Long Term Care Information. The length of the home care visit will depend on your needs and condition, but on average, expect to pay about $168 per day.

Click here for more information about home care.


A Program of All-inclusive Care for the Elderly, sometimes known as a PACE program, is available to older adults who quality for nursing home care but wish to live at home.

Catholic Health’s PACE program, called LIFE (Living Independently for Elders), offers medical services at the LIFE center, at your home or at an off-site location. Transportation to and from appointments is included.

LIFE pays for all authorized services for individuals eligible for both Medicare and Medicaid. If you do not have Medicaid, you will be charged a monthly premium to participate in LIFE.

Click here to learn more about LIFE.

Medical Adult Day Care

An adult day care program offers many of the services that you could find in a nursing home, such as physical therapy, nursing care and nutritional counseling. Participants are able to live at home while receiving care at the day center.

At this time, Catholic Health charges $133 per day for this service, although prices are subject to change. Medicaid will cover the cost of adult day care, and some long-term care insurance plans will pay a portion of the fee. Medicare will not cover the cost of this program.

Click here to learn about Catholic Health’s medical adult day care program.

The costs of long-term care can be intimidating, but knowing your options and what resources are available to you ahead of time can help to ease the financial burden. Government programs provide medical assistance to those who cannot afford long-term care. Insurance programs and alternatives to nursing homes are also available to help make your long-term care more affordable.

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