Planning for Long-term Care

for

Long-term Care

Cheryl K. David Estate Planning and Elder Law Attorney Law Offices of Cheryl David

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PLANNING FOR LONG-TERM CARE Planning for long-term care either for you or a family member is a task most of us are reluctant to consider. Long-term care may be needed at any age, but the possibility of an individual requiring some form of long-term care increases as we age. Those of us over age 65 have a 70% chance of needing Long-term care may long term care in our lifetimes. One in three will receive some be needed at any form of residential care in an assisted living center or nursing age, but the home. possibility of an Long-term care is needed when we are no longer able to individual requiring some form of longperform activities of daily living, such as bathing, transporting term care increases and eating. We may also require assistance with what are as we age. considered instrumental activities of daily living, which include preparing and cleaning up after meals, housework, paying bills, caring for pets and remembering to take daily medicines. Thankfully, not every family needs long-term care, but given our longer life spans, many will have this need. Your choice of facility is an important consideration, and should be thought out well in advance of the day when you or a loved one enters the doors. It is very important to make decisions regarding long-term care in advance of your need. First, you need to make decisions at a time when you are physically and mentally capable of doing so. Given the importance of your care choices, it is best not to make choices under the pressures of a strict deadline. Equally important is the effect that stress can have on your body. Your recovery and rehabilitation will progress more quickly if you are not facing the tasks of planning your care when you have an urgent need.

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WHAT FACTORS SHOULD I CONSIDER WHEN CHOOSING A LONG TERM CARE FACILITY?

The quality of care is clearly a very important consideration so you should do your research. Ratio of patients to staff is usually recommended to be six or eight to one. Also, the skill level of the staff is important as there should be some RNâ&#x20AC;&#x2122;s on staff in addition to medical assistants. You may wish to visit any centers you are interested in several times, at varying times of day, to note any differences in the level of care available. If you are able to make unannounced visits, take advantage of that opportunity.

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One of the things many people focus on is location. This is only natural, as we want to be near our family and friends. Many people also give great consideration to the physical layout of the building. Well-lighted, bright areas and wide doorways and halls are important, visually and from a safety perspective. Views of woods, mountains or water also contribute to the physical charm of the facility

WHAT ARE THE COSTS OF LONG TERM CARE? Costs vary according to the services rendered and your location. If you need someone to come to your home, current costs in North Carolina for housekeepers and home health aides are averaging $17 and $18 per hour respectively. Services available at adult day centers are currently estimated at $47 per day.

Medicare and most private health insurances will pay little or none of the costs associated with long term care. They are concerned with costs of doctors and hospitals and will exclude most services.

Those requiring residential care are looking at rates of $3397 monthly for assisted living centers. Nursing home care is averaging $182 daily for semi private rooms and $204 for private accommodations. Keep in mind that prices may be higher in the Charlotte and Raleigh/Durham areas than the Piedmont Triad.

These costs may not include all of your costs as some facilities may charge for additional services.

WONâ&#x20AC;&#x2122;T MEDICARE AND MY PRIVATE INSURANCE COVER THE COSTS OF LONG-TERM CARE? Medicare and most private health insurances will pay little or none of the costs associated with long term care. They are concerned with costs of doctors and hospitals and will

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exclude most services. It is always advisable to carefully review your existing policies. If you have purchased long-term care insurance, these policies must also be looked over carefully. Most will cover room and board, but only at approved facilities. You will in most cases have to pay most of the costs of long-term care out of your pocket. This will be in addition to maintaining your current household budget.

WHAT ABOUT MEDICAID? Medicaid may indeed help with your long-term care. To qualify, you must meet income and asset limits, and in addition, there are asset transfer requirements. In some cases, the state may place a lien on your estate to recover their costs. State requirements are subject to change, and you can get some answers from your county Department of Social Services. Additionally, and oftentimes preferably, you may want to seek legal council of an experienced Elder Law and Medicaid attorney. There are many strategies that can be employed to help you qualify for Medicaid while still preserving your assets, including your home and life savings. Income and asset limits are relatively straightforward. Your income is what it is. Also your primary residence, your car and your personal possessions are generally exempt from the asset test. Beyond this, state regulations are often as complex as any tax code ever written. When and how you have disposed of assets may also affect your eligibility. Current regulations allow a look-back period of five years for disposal of assets. This has increased from a traditional period of three years.

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You will most likely have to pay some of your income toward your care. In North Carolina, this is referred to as monthly patient liability. Other states may use terms such as share of cost or meeting your spend down.

CONCLUSION Given the complexities of the Medicaid program, many people seek the help of an elder law attorney when making plans for long-term care. These highly focused professionals will meet with you to discuss your needs and your current financial status. They are in the best position to confidentially advise you in this constantly changing environment. Their experience and expertise will help you chart the best course given your unique situation.

REFERENCES http://www.longtermcare.gov/LTC/Main_Site/index.aspx http://www.medicare.gov/ http://www.ncdhhs.gov/dma/medicaid/

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ABOUT THE AUTHOR About the Author

Cheryl David is a graduate of UNC-Chapel Hill, the University of Baltimore School of Law, and the prestigious Trial Lawyerâ&#x20AC;&#x2122;s College presided over by Gerry Spence. A former Administrative Judge, Cheryl is certified as an Estate Planning Law Specialist by the ABA accredited Estate Law Specialists Board, Inc. She is also a member of the American Academy of Estate Planning Attorneys, Medicaid Practice Systems and the National Academy of Elder Law Attorneys. In 2008, Cheryl received the honor of becoming a Fellow with the American Academy of Estate Planning Attorneys. The Fellow program recognizes Academy Members who demonstrate advanced expertise and significant practical experience in the total estate planning, trust, tax planning, guardianship, probate and estate administration fields. In order to maintain this advanced expertise, Cheryl takes over 36 hours of continuing education in Estate Planning, Elder Law, and Taxation each year. Also a Financial Planner, she holds the Series 7 and 66 Investment Licenses in addition to both Insurance and Long Term Care/Medicare designations. Her professional capabilities, together with over 25 years in practice, have combined to bring positive change to the lives of over 4500 clients and their families. 528 College Road Greensboro, NC 27410 Phone: (336) 547-9999 Fax: (336) 547-9477 WWW.CHERYLDAVID.COM

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