When long-term care needs arise, the situation requires many decisions — involving financial, legal and geriatric care matters. A lot of stress, anxiety and confusion can accompany this required decision-making, because the tendency to put off any long-term care planning is so prevalent. Many people just do not want to think about aging or the possibility of needing a caregiver, much less planning for the end of life.
Long Term Planning is Essential but Often Overlooked
The facts do indicate that individuals and families need to plan for long-term care in the same way that they plan for funding an education, developing a career, starting a family and retiring. The probability that an individual older than 65 will become cognitively impaired or unable to complete at least two "activities of daily living" (including dressing, bathing or eating) during his or her lifetime is 68%. In addition, an estimated 43% of those 65 and older will spend some time in a long-term care community.
While individuals may realize that they should prepare for long-term care, most simply do not. Consequently, many individuals find themselves suddenly immersed in a dire situation demanding that they deal with a system, understand terms and handle affairs — all unfamiliar to them. VOYCE has compiled a Consumer Resource Guide and Directory to help individuals navigate this unfamiliar territory and understand their options for when and how to find expert resources and services for financial, legal and geriatric care planning.
Financial Resources to Pay for Long-Term Care
One of the top concerns among people facing the need for long-term care is deciding how to pay for it. The following is a brief synopsis of the various available financial resources:
I. Pay with Your Own Funds (Private Pay)
Many people must use their own funds at first; this means that individuals must pay for their long-term care costs out of their own pocket. Unfortunately, few people can afford the high cost of long-term care for a long time, and Americans are living longer than ever before. The average U.S. life expectancy for the 21st century has increased to 77.5 years from 49 years at the turn of the 20th century. The cost to live in a long-term care community, especially an intermediate or skilled nursing level of care, averages between $5,500 and $7,000 per month for this area (Greater St. Louis and northeast Missouri).
II. Long-Term Care Insurance
Long-term care insurance generally covers some of the cost of home care, assisted living, intermediate or skilled nursing care. Because coverage varies between policies, it is best to review any long-term care insurance policy with a financial representative and ask for a written definition of exactly what the insurance will cover.
III. Department of Mental Health
Certain long-term care communities contract directly with the Department of Mental Health for individuals to receive care as long-term care residents under the State Hospital Community Placement Program, which includes a clothing and personal allowance.
IV. Veterans Benefits
Many people overlook the U.S. Department of Veterans Affairs (VA) as a resource to pay for long-term care. All veterans can apply for residence at one of the state veterans long-term care communities. These residences usually have a waiting list for admission, and the length of the wait depends on both the individual's condition and a priority category that the VA assigns.
V. Medicare Benefits
Individuals may qualify for limited long-term care coverage from Medicare if a hospital has admitted them for three days within the previous 30 days and they need follow-up skilled nursing care that they receive in a Medicare-certified bed. This Medicare coverage is for a maximum of 100 days with the average length of care lasting 28 days. Medicare Part A will pay in full for the first 20 days. After the first 20 days, Medicare requires co-pay of 20 percent from the individual. Most Medicare supplemental insurance (and Medicaid) will cover the amount of the co-pay, but only for as long as the individual is benefitting from rehabilitation efforts. While Medicare Advantage Plans have different rules regarding the required length of hospitalization and schedules for when co-pays become effective, these plans still offer full or partial coverage for a maximum of 100 days. Read more here.
VI. Medicaid Benefits
Both the federal and state governments fund Medicaid — the medical services assistance program for low-income individuals. In Missouri, the Family Support Division (FSD) administers this assistance program called Vendor Medicaid, which pays indefinitely (unlike Medicare) for the care of qualified individuals who reside in intermediate care or skilled nursing settings. Vendor Medicaid generally pays the difference between the person's income and the total bill each month. An individual must meet the following criteria to qualify for Vendor Medicaid:
This is just a small sampling of the content available in the Consumer Resource Guide and Directory. Purchase this Directory to learn more and let our VOYCEconnect specialist walk you through the options for finding and financing long-term care by calling 314-919-2403.
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