Planning For Long-Term Care

In my last post, I wrote about two people who used up their Medicare benefit for in-patient skilled care but were not able to return to an independent life. One ended up opting to stay in a nursing home. The other went home with home health care services, a family caregiver and additional assistance from a home care worker. Neither of these individuals was aware that Medicare coverage for skilled care has a limit—in any given benefit period—and that they would find themselves in need of long-term care services. They also did not realize that Medicare does not pay for long-term care, which resulted in additional stress and confusion in an already stressful and confusing time. Unfortunately, many of us could easily find ourselves in this position.

I am a big advocate of advance planning. There is legal paperwork to draw up a will, and to designate a power of attorney for property and health care. However, there is no equivalent document where you can designate your preferences for the type of long-term care that you want. Yet if you fail to have a plan for long-term care, you are the one who will suffer the consequences. For that reason, it is important to think about, plan and discuss your preferences with family members before the need for long-term care arises.

You know a lot about yourself. You know your health status, your health history and your family health history. With this knowledge. you can make some assessment of your personal risk factors and what that implies for your future needs. For example, if there is a strong history of Alzheimer’s disease or other dementia in your family, you are more likely to end up needing long-term care services than if that were not the case.

You also know your financial status and prospects. Can you afford to pay in full or in part for long-term care? For how long? Do you have long-term care insurance? Do you understand your policy? Are you or will you be eligible for Veteran’s benefits or Medicaid? You also know your social network. Are there family members, a spouse or children, who are in a position to provide care? What about friends?

Your plan has to answer two fundamental questions: How will you pay for long-term care services and who will provide it?

Needless to say, if you among the minority of people who have the resources to pay for several years of long-term care, you are very fortunate. Those who don’t have the sufficient financial resources or who don’t want to use invested savings to pay for two to three years of care may want to explore long-term care insurance and/or some of the newer life insurance options that can be used for long-term care. You should discuss these options with your family and a financial advisor you trust since there is a lot to consider before you make your decision. If you are a veteran, you may be eligible for benefits for long-term care. Or you may also qualify Medicaid and/or Home Based Community Services in your state if you are low income.

After you have considered how you might or might not be able to finance your long-term care, it is very important to talk to family members. Unless you have pre-arranged for your care by moving into a continuing care retirement community, it is important for you to discuss your preferences for the kind of care you want: at home, in an assisted living facility, if appropriate, or in a nursing home. This has to be an open and realistic discussion, particularly if your preference assumes that a family member will provide some or all of your care. Will your spouse be physically and psychologically able to care for you? Can your son or daughter take enough time off from work, or from their own lives, to provide the level of assistance you might need? Have this discussion, even if you are able to pay for your care. And, finally, make sure to put your plan is writing. A conversation alone can easily be forgotten, or remembered differently by others. Keep in mind that it may be another family member and not you who has to make the choices and the arrangements when the time comes that you will need the care.


  1. Silas Knight says:

    Thanks for the information about planning for long term care. I agree that planning is vital, and that you should look at yourself and your family history for this planning. I will definitely remember all of this as I get a little older.

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