Long Term Care

The Uncertain Future of the Aging Middle Class

November 29, 2021Filed Under: Elder Law, Long Term Care

As we grow older, physical activities become more difficult, and most seniors will suffer from some form of decline in health. That’s a truth all of us know. What you may not realize is that the aging middle class will face unique difficulties going forward. The private market offers options for assisted living, but at a price too high for the middle class; and those same people often have too much to qualify for Medicaid or subsidized housing. See Health Affairs article on the same.

Moreover, the adults stuck in this bind have fewer assets to fill the gap. They have more debt and less savings, are less likely to receive pensions, and are likely to have smaller families to turn to for support as they age.

So what will fill the gap in the coming decade as more and more seniors require, but cannot afford long-term care?

The government could seek to incentivize the private market by expanding tax credits to developers of low-income senior housing, as a New York Times article suggests. The United States, like many Western democracies, could turn to public programs to fund long-term care or shift the boundaries of Medicaid to cover seniors above the current cut-off line, or to cover costs like housing instead of just health care. Given the increasing pressure on Medicaid and the difficulty of accruing political capital for such hot-button issues, those expansions seem unlikely.

Will the private market respond to demand, and start offering lower-cost options on its own? Long-term care insurance (LTCI) may be an avenue for growth, as discussed in this Commonwealth Fund article. Private LTCI options have become increasingly popular since their emergence in the 1970s, and despite some flaws, from underwriting and actuarial uncertainties to inflexible designs, LTCIs is overall a sound investment.

Planning for the possibility of needing long-term care in the future is something we can assist with. We can also provide guidance in how that care will be paid for, without sacrificing all of your savings. If you are interested in discussing an asset protection plan that focuses on long-term care, please contact our Cincinnati office by calling us at 513-771-2444.

Considerations for Long-Term Care Insurance

October 25, 2021Filed Under: Long Term Care

In order for the elderly and disabled to receive the personal and health support they need, long-term care insurance can be the solution. However, it is important to understand long-term care insurance before the time comes when the benefits are needed. Unfortunately, many people wait and then miss out on what long-term care insurance can offer.

Should I get long-term care insurance?

There are a few things to consider before you go out and purchase long-term care insurance. First, consider your age. Age is important because it is much cheaper to get long-term care insurance at a younger age. Older adults and those who already have existing health conditions may have more difficulty getting long-term care insurance and the premiums are guaranteed to be costly.

Second, consider your support system. In other words, do you have family who will be able to help provide for your care needs in the future? If so, then you may not need long-term care insurance. This is definitely a good time to sit down and talk about the future with your family.

Third, consider your savings and investments. This is where a financial adviser or elder law attorney can help you understand ways to pay for long-term care and whether or not long-term care insurance is right for you.

What is the cost of long-term care insurance?

The cost of long-term care insurance cannot be attached to specific numbers. The cost depends on age, gender, marital status, the insurance company, and the amount of coverage. The younger a person is when they get long-term care insurance, the lower the premiums will be. Generally speaking, long-term care insurance policies are less expensive for men than women. This is due to the fact that women generally live longer and therefore are more likely to make claims on the long-term care policies. Married people have lower premiums than single people. Just like with any type of insurance, rates for long-term care insurance will vary from one company to the next. It is important to shop around and compare the costs of long-term care insurance with a variety of carriers. The amount of coverage desired greatly affects the cost of long-term care insurance. Better coverage with fewer restrictions will come at higher premiums. Be sure to do your homework, talk to your financial planner, and elder law attorney to help determine long-term care insurance needs.

What does long-term care insurance cover?

Once you have a long-term care policy, you are eligible for benefits if you have dementia or another cognitive impairment or you are unable to perform at least two of six activities of daily living. These activities include bathing, dressing, eating, toileting, caring for incontinence, and transferring. When a policyholder is eligible and in need of filing a claim on long-term care insurance, a variety of services may be covered. Nursing homes and assisted living facilities may be covered services. Within those services, policies may only cover room and board or they may cover more extensive services. Long-term care insurance also covers adult day care services for those who need a program for health, social, and other support services during the day. Home care is also provided under some long-term care insurance. This service helps with activities of daily living in the policyholder’s home. When home adaptations are necessary, such as ramps or grab bars, long-term care insurance can cover these services. Care coordination and future service options are also available services within long-term care insurance policies. You will need to understand your specific policy to determine the specifics of the services covered and to what extent they are covered.

Long-term care insurance can seem very complicated. Remember there are professionals who specialize in helping to determine long-term care insurance needs and coverages. A great place to start is with your financial advisor and elder law attorney. If you’d like to discuss your particular situation, please don’t hesitate to reach out. Please contact our Cincinnati office by calling us at 513-771-2444 with any questions.

A Guide for Parent Caregiving

June 21, 2021Filed Under: Estate Planning, Long Term Care

Something that affects all of us and our families is aging. It can be challenging for adult children to imagine their parents as seniors and to understand and respond to the reality that each parent will age differently. Even if you are in the fortunate circumstance where your aging parents can go it alone for a long time there will come a day when assistance or long term care will be needed. There are things to consider as you help your parents live their best possible aging scenario. Managing their welfare takes time, research, and planning.

Your parents and their abilities to remain independent are most easily defined by activities of daily living and instrumental activities of daily living (ADLs and IADLs). Activities of daily living address daily functional mobility like getting in and out of bed or a chair, self-feeding, bathing and personal hygiene, the ability to use the toilet, and the ability to get dressed. These are essential daily living requirements that promote dignity and physical as well as emotional well- being for your elderly parents. If your parents are having difficulty managing these ADLs, it is an appropriate time to find help for them whether it is you or another qualified caregiver.

IADLs include all ADL activities and more. The additions are grocery shopping and cooking, medication management, laundry, and other housework, bill paying and finance management, using a telephone, and driving or using public transportation. Recognizing your parent’s limitations in any of these categories is a sign that you need to develop a care plan that provides appropriate assistance. The degree of change or sometimes multiple changes is an indication that staying at home may no longer be appropriate and safe for your parent. If you require assistance in determining suitable care needs, you can set up a comprehensive geriatric assessment by a medical professional. Take an honest look at the stage of life your parent is experiencing and then find the support and help they require.

Your aging parents’ geographical location is critical to consider as a family. Families are fortunate when one adult child lives nearby and can ensure their parent’s well-being. Video chat either online or through a phone application is one way to daily check on a parent. A friend may live close by and can do wellness checks and provide information about behavioral or health changes. If none of these options are viable, it may be time to discuss the idea of your parent(s) downsizing into another more supportive location and living arrangement.

Having this discussion is best before a parent’s adverse health event. Making residential changes without a previous plan in place can negatively impact on the parent, especially when experiencing a health care crisis. When aging at home cannot be appropriately managed, it is time to consider the alternatives. These alternatives may include independent living communities, assisted living communities, nursing homes, or living with a trustworthy and capable relative or family member.

All of these assessments and changes in your parents’ lives impact their financial outlook. Making necessary residential changes can often be very costly, and your parent may need additional financial support from government or community programs to offset the difference in expenses. It is critical to take advantage of all possible financial help. As an adult child, you may have to begin managing their finances and retirement funds more actively. There are various federal, state, and non-profit groups that provide free tax assistance for seniors.

Some of the better organizations to help you navigate what is available are online and include Benefits.gov, Area Agency on Aging, and Benefitscheckup.org. These groups can help you assess the best strategies for housing, healthcare, financial assistance, legal aid, transportation, in-home services, prescription drugs, energy and utility support, and nutrition. BenefitsCheckUp is part of the National Council on Aging and is considered the nation’s most comprehensive online service for seniors with limited income and resources. The information available canvases all 50 states and the District of Columbia.

Caring for your aging parents should not be the job of one family member. The commitment should not be a burden, and responsibilities should be shared. Look for caregiver support organizations and forums as well as involving all family members. Everyone should do their part. The goal is to find the best blend of options and resources to allow your parents to age happily and well. Your parents’ health changes require that programs and opportunities change too. Caring for your aging parent is a dynamic process that must be retooled as their needs change.

We help families who are trying to navigate the maze of long term care either for themselves or for an aging parent. If you’d like to discuss your particular situation, please don’t hesitate to reach out. Please contact our Cincinnati office by calling us at 513-771-2444 with any questions.

Your Parent May Need More than Assisted Living

June 14, 2021Filed Under: Long Term Care

Jerry’s mother Jane decided, on her own, that it was time to move into an assisted-living facility. Jane’s arthritis had worsened to the point where she couldn’t dress herself, she struggled to get in and out of the shower, and she was lonely living by herself.

Jane did very well at her new place. The social activities helped her mood, the staff was available to help her bathe and to monitor her medication for her, and she appreciated not having to cook any more.

However, over time Jane showed signs of dementia. The facility she had moved to was simply not set up to meet her needs. Dementia patients can become disoriented, wander away into danger or exposure, or become agitated or aggressive. Dementia is a particularly difficult disease to care for, as the right balance must be struck between sufferers’ need for social contact and mobility on the one hand, and safety for themselves and others on the other hand.

There are facilities that provide “memory care” services, with locked doors to prevent wandering, but these are usually more expensive and Jane’s wasn’t one of them. If the facility doesn’t have staff trained in how to “talk down” and reassure an agitated or aggressive resident, staff may over-rely on psychotropic medication. But over-medicated patients are exposed to increased risk for strokes, falls, and confusion. Staffing and training regulations vary widely across the states, and often the staff-resident ratios are left to the facilities to determine. For-profit facilities must balance staffing expenses with attention to their bottom line. The problem is particularly acute in rural areas, where there are fewer facilities available.

It’s particularly important, then, that residents’ family-members keep tabs on the facility’s environment and treatment of residents. Here are questions to look out for:

Is the facility is clean, sanitary, and in good repair?
What is the ratio between staff and resident?
What training does the staff get? What is the staff turn-over rate?
Are residents medically assessed at least once a year?
Are the hot-water temperature controls kept at a safe and effective level?
Are the following kept away from residents: Alcohol, cigarettes, and toxic cleaning supplies and disinfectants?
Are medications kept in a safe, locked place that is not accessible to anybody other than employees responsible for the supervision of the medication?
Is safe storage provided for knives, matches, firearms, tools, and any other items that could constitute a danger?
Are there provisions in place to protect life and property against fire and panic?

With careful monitoring, assisted-living facilities may provide a safe environment – but monitoring can also flag when the environment is no longer safe enough.

We help families find, access and pay for long-term care. I If you’d like to discuss your particular situation, please don’t hesitate to reach out. Please contact our Cincinnati office by calling us at 513-771-2444 with any questions.