4th Step In Elder Law Process – What Should I Consider When There Is a Need for Skilled Nursing Care?
As the average life expectancy in the United States continues to increase, most people can expect to spend a much larger portion of their lives in their retirement years. While living longer is certainly something to look forward to, it also increases the likelihood of needing long-term care at some point in your life.
If you find yourself faced with the need for skilled nursing care for yourself, a spouse, or parent, what factors should be considered when selecting a facility?
Geographic Considerations
The simple truth is that no one wants to move to a nursing home. If you are married, you may have spent the majority of your life looking forward to sitting on the front porch of your home with your spouse growing old together. If you are an adult child, you may find yourself stretched thin trying to care for a parent who really should have around the clock skilled care. The desire to remain in the home causes many families to delay the decision to move a family member to nursing home care long past the point at which it should have been made. If you are now at the point where the need for skilled nursing care can no longer be avoided, one of the most important considerations when choosing a facility should be the facility’s location.
Choosing a facility that is close will help ease the transition to skilled care, both for the patient and for family and friends. If it is your spouse who needs care, and you plan to remain in the community, a facility that is within a 15-20 minute drive is preferable. Even better, look for one that can be easily accessed using public transportation if possible. If it is a parent who needs skilled nursing care, consideration should be given to other family members and close friends as well. When possible, look for a facility that is centrally located and within an hour drive for those people who are likely to visit on a regular basis.
Types of Skilled Nursing Care
Another important consideration is the type of facility. Skilled nursing care can be found at several different types of long-term care facilities. A traditional nursing home is at one end of the care spectrum, offering around the clock medical care. The atmosphere in a nursing home is more akin to a hospital, as a general rule, than to a retirement community. As such, you may have a roommate in a nursing home, but it won’t be your spouse.
If you do want the option to remain with your spouse, a continuing care community might be a better option. Also referred to as “multi-level care facilities,” these communities offer independent living for as long as residents are capable of living without assistance; however, they also offer skilled nursing care in the event you or your spouse (or both) reach a point where it is needed. These communities tend to be very self-contained, offering social activities, banks, gyms, transportation services, and routine medical care all within the confines of the community. Not surprisingly, these communities often have long waiting lists and can be rather pricey.
Paying for Care
Most people are shocked at the cost of long-term care in the United States. For 2017, the average nationwide cost of a year in long-term care was over $80,000. Of course, that figure can fluctuate considerably depending on the type of care you choose and where the facility is located. The cost of care, however, is something that should be considered in any case. There are several options for covering the cost of skilled nursing care, including:
- Paying out of pocket – paying out of pocket is always an option; however, given that the average length of stay in a long-term care facility is 2.5 years, your retirement nest egg is likely to diminish, if not disappear, if you are forced to pay out of pocket indefinitely.
- Long-term care insurance – most health insurance policies specifically exclude long-term care expenses. You can, however, purchase a separate long-term care insurance policy. The younger you are when you purchase the policy, the lower the monthly premiums will be. Keep in mind though that you must pay those premiums without fail until such time as you need the benefits offered by the policy. If you did not purchase a policy when you were younger, purchasing one now will likely be cost-prohibited, if not impossible.
- Medicare – you may be surprised to learn that Medicare only covers nursing home care under very strict conditions – and even if those conditions are met, Medicare Part A will only cover up to 100 days in a skilled nursing facility per “spell of illness.” Moreover, if you stay for more than a few days you will have a significant co-pay. If you have Medigap the co-pay will likely be covered by that policy. If not, you will be responsible for paying the co-pay.
- Life insurance benefits – depending on the type of life insurance policy you have, you may be able to use some, or all, of the death benefits to cover long-term care expenses. Keep in mind, however, that if you use your death benefits to cover skilled nursing care, those benefits will not be available for loved ones to use after your death.
- Medicaid – unlike Medicare, Medicaid will cover expenses related to skilled nursing care indefinitely and without as many conditions precedent. The catch though is that you must first qualify for Medicaid. For seniors with significant assets, this can be problematic if you did not incorporate Medicaid planning into your estate plan at least several years ahead of the need to qualify for benefits. Never assume that it is too late though because there are some last-minute Medicaid planning strategies that may still work for you.
Jeff Jinks Attorneys Can Help
We understand that choosing and paying for a skilled nursing care facility can be challenging. Our team is dedicated to providing you with legal and financial counseling that can help you navigate the numerous options available and find solutions that work for you and your family. Our firm includes not only the legal expertise needed in these situations but also a Senior Liaison with over 30 years nursing home management experience who is able to assist families facing this decision process.
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