Consumers Guide for Long Term Care Planning

The Life Care Approach

Learn:

How to find, get and pay for good care.

How to navigate the Long-Term Care Maze.

How to protect the home and other assets.

How to coordinate care for your loved one.

How to prevent caregiver stress and burnout.

Provided as a Service by

the Elder and Disability Law Firm of

VINCENT, ROMEO & RODRIGUEZ, LLC

Members, Life Care Planning Law Firms Association, National Academy of Elder Law Attorneys, Inc.

Introduction

Long term care is defined as the personal assistance that enables an impaired person to perform their activities of daily living -- eating, dressing, bathing, etc. As people age, they are increasingly vulnerable to chronic conditions which may impair their ability to perform these activities of daily living independently. This year, in the United States, roughly nine million men and women over age 65 will need long term care. By 2020, 12 million older Americans will need long term care. Over half of the "oldest old," those persons over age 85, are impaired and require long term care. In addition to the elderly, a significant population of younger disabled adults require some form of long term care.

When a person is no longer able to meet their needs on their own, they enter the long term care system. Unfortunately, in our country, this "system" is not a system at all, but a hodgepodge of providers, services and programs that can be very difficult to access. The maze of options for housing, medical care, assisted living, in-home care, and nursing home care can be truly daunting to navigate. Assuming good care can be located, significant challenges remain as to how to finance such care. Medicare, Medicaid, Veteran's benefits, long term care insurance, reverse mortgages, etc, all can play a role.

Life Care Planning is a concept designed to assist older and disabled clients and their families in navigating the long-term care maze. Life Care Planning is a process of locating, accessing, coordinating, and paying for high quality care to maximize independence for as long as possible; in other words, to "age in place" and remain at home (or out of a nursing home) as long as possible.

THE CONTINUUM OF CARE

The first step utilized in Life Care Planning is to determine where the person is on the Continuum of Care. The attached chart shows four major areas that are used in this analysis: functional limitations; housing; cost of care; and public benefits and other resources.

A. Functional Limits: Functional limits generally refer to a person's ability to independently perform their activities of daily living ("ADLs"). ADLs are those activities that are essential to maintaining good health and safety. They generally include the following: eating, bathing, transferring, walking, toileting and dressing. Other important functional activities may include driving, and keeping track of finances and bills. As a person progresses along the Continuum of Care, they need more and more assistance with these ADLs.

B. Housing: The second line of the Continuum refers to a person's residential options. Ideally, most people wish to stay in their own home, remain independent, then die in their sleep. For a lucky few, this may really happen. But for the rest of us, good planning will be needed to maximize our independence as long as possible. Good planning involves considering where we currently live, as well as what our living arrangements may be in the near, as well as distant, future.

The goal in residential planning should be to meet the loved one's needs for a safe and secure environment with minimal constraints on the person's day-to-day activities. For persons who are elderly and disabled, this goal may often be met by bringing care into the home, making safety modifications to the home (grab bars, flooring, etc.), and improving monitoring and oversight functions (e.g. emergency response systems) - see attached Home Safety Assessment form. However, for others, the goal can only be met outside the home. Options outside the home, include the following:

  • Senior Independent Living Facilities - these facilities are specifically designed for elders who remain independent, and may consist of condos or apartment complexes with full kitchens and private baths. Services provided can include meal plans, transportation, housekeeping, laundry. Amenities may include swimming pools, libraries, computer stations, bar areas and other social gathering places.
  • Assisted Living Facilities - Assisted living facilities are designed for those who may no longer be able to live on their own safely, but who do not require the high level of care provided by a nursing home. Services provided often include meal plans, housekeeping, medication management and assistance with most ADLs (including dressing, bathing, feeding, transferring, etc.) Residents typically live in their own apartment and eat in a central dining area and staff is usually available 24 hours per day. These communities also typically provide transportation services and scheduled social activities.
  • Residential Board and Care Homes - These usually consist of a home in a private residential area where 3 to 5 residents live together and receive care from live-in caretakers. Board and Care Homes (also known as group homes, adult family homes, adult foster care) can provide a more "home-like" living condition with a back yard, pets, a piano and other amenities. Residents often have their own room and eat together "family-style." The level of care services provided varies greatly among these homes, and can range from assistance with a limited number of activities of daily living to services almost comparable to those provided in a nursing home setting.
  • Nursing Home - These facilities provide 24-hour skilled nursing care for those individuals who require a high level of medical care and assistance. Rooms may be private or semi-private and meals are typically served in a central dining area, unless the resident is too ill or impaired to participate. These facilities are also used for rehabilitation purposes following hospitalization, where the patient is stabilized and can be expected to return home in the near future. Some have secured units for patients with dementia who may be at risk of wandering. Monthly costs can average between $8,000 to $10,000 per month in the Denver, Colorado area.
  • Adult Day Care Facilities - An increasingly popular option for family members who may work, or who simply need time off caring for an elderly or disabled loved one, are adult day care facilities. Individuals may be dropped off at the facility during the day (or in some cases, evenings) where they are watched by staff. Activities, snacks and meals are often provided. Services may be provided on an hourly, daily or longer term basis.

A Life Care Plan seeks to address and improve situations where an individual with certain functional limitations is in the "wrong" living situation; for example, an individual living at home with physical problems and early stage dementia, who would end up in a nursing home much sooner without medication management, home care services or adult day care.

C. Cost of Care: The cost of care is obviously a major factor to weigh in creating a Life Care Plan. Costs can range from a few hundred dollars a month for housekeeping and a few hours a week of personal assistance, up to $9,000/month or more for nursing home care, depending on where the individual is on the Care Continuum and the amount of services they require.

D. Public Benefits and Resources: Analyzing a person's income and assets and determining how best to utilize them to pay for good care is an essential part of the Life Care Planning process. Determining eligibility for public benefits, such as Medicaid, and accessing such benefits, is one of the more challenging aspects of planning. There is much misinformation concerning benefit programs and how to qualify for them. We have prepared a separate guide on the Medicaid program and encourage everyone considering applying for Medicaid to review it. Among other things, the following must be considered in a Life Care Plan.

  • Fixed Income: This refers to Social Security and Pension income. These resources, while reliable, are often inadequate to cover the costs of long term care.
  • Investments and Savings: Good planning involves obtaining good advice on how funds can be safely invested and tapped to improve quality of life and quality of care. A knowledgeable investment advisor should be part of your team.
  • The Home: For many persons, the home is their most significant asset. Careful consideration must be given to the best use of this asset in the Life Care Plan. Should the home be sold? Should a reverse mortgage or home equity line of credit be taken out? What are the rules about preserving the home for the spouse, or transferring the home to children and qualifying for Medicaid?
  • Long Term Care Insurance: A primary purpose of long term care insurance is to provide access to quality care. Modern policies provide a pool of money that can be used flexibly to pay for home care, assisted living, or nursing home care. Working with a specialist in this area is always recommended.
  • Medicare and Health Insurance. Long term care planning must consider adequate health insurance coverage, both through Medicare and private and supplemental policies. Unfortunately, Medicare provides only limited coverage for home-based care and rehabilitative services in a nursing home (usually up to a maximum of 100 days). These benefits are often misunderstood and underutilized.
  • Medicaid: Medicaid currently pays for almost half of all nursing home care in the United States. The rules relating to eligibility for this program are complex and widely misunderstood. For instance, married couples do not have to spend down all of their assets and become impoverished before they can obtain Medicaid eligibility. Spouses may be entitled to retain part of their spouse's income, as well as their home, car, all their personal property, and over $123,000 of other assets and still receive Medicaid. Indeed, there are some strategies that can preserve all of a couples' assets and one-half or more of a single person's assets. Since the Medicaid rules are so complex and constantly changing, however, you should seek help from an experienced Elder Law attorney for this type of planning.
  • Other Programs: Veteran's benefits may help defray some of the costs of long term care for qualified individuals who have served in war time, as well as for their spouses. These benefits may include disability compensation, pension benefits, Aid and Attendance, health insurance and nursing home care. As with the Medicaid program, rules in this area are also very complex. Other government benefits which may be considered as part of a Life Care Plan include: Old Age Pension (which provides a minimum level of income to needy Colorado residents age 60 or older); Low-Income Energy Assistance (winter heating subsidy); Food Stamps, and property tax exemptions.

CONCLUSION

Navigating the long term care maze can be difficult and frustrating. Life Care Planning is a concept designed to help you find, coordinate and pay for the best quality care for your loved one. It can allow you or your loved one to "age in place" longer, as opposed to having to move to an assisted living facility or higher level of care. Life Care Planning law firms, which often have social workers, geriatric case managers or trained care coordinators as members of their staff, can provide families with valuable information and tools with which to maximize independence and quality of care, while preserving family assets. If you are considering a Life Care Plan, you may wish to contact the Life Care Planning Law Firms Association at www.lcplfa.org. or (520) 270-1541.

Provided as a service by the Elder and Disability Law Firm of Vincent, Romeo & Rodriguez, LLC, Members: Life Care Planning Law Firms Association, National Academy of Elder Law Attorney. Offices in Metropolitan Denver and Boulder, Colorado 303-500-5859 ; 303-720-7260 ; www.elderlawcolorado.com.

NOTE: THIS DOCUMENT IS A SUMMARY AND IS FOR INFORMATIONAL PURPOSES ONLY. BECAUSE LAWS MAY CHANGE AND THE RESULTS MAY VARY BASED ON PARTICULAR FACTS AND CIRCUMSTANCES, CONTACT AN EXPERIENCED ELDER LAW ATTORNEY PRIOR TO ACTING ON ANY SUCH INFORMATION.

© Vincent, Romeo & Rodriguez, LLC