This becomes a topic when someone you know or love can no longer safety care for themselves. And while this could be because of physical impairment, more often then not the reason has to do, at least in part, with a mental decline. Call it “dementia” or “Alzheimer’s” or whatever you chose, but most situations in which long term care becomes a topic involved an older person with some diminished capacity.
A One Way Street
They call it “long term” care for a reason. When these situations arise, they are almost always going to continue for the rest of that person’s life. Age-related cognitive impairment is almost always irreparable and will almost certainly get worse over time. So to plan, you have to assume the situation won’t go away, and the needs will only increase over time.
Medicare, Medicaid and Cash Dollars
Medicare, which almost all seniors citizens have, pays for only a very limited amount of long term care, typically in a rehab facility. As a result, a very high percentage of elders who need assistance with long term care end up on Medicaid. That means they go through the complicated “spend down” process, often seeking help from an elder law attorney to understand what can be done to protect their resources in this process.
Of course if you enough cash money, you don’t have to worry about government programs. But with the cost of long term care typically running from $6000-$12,000 a month, few people can avoid considering government programs.
Staying Home
Most people want to “stay home” and most families want to keep their loved ones in their home for as long as possible. Often times this can be accomplished, at least in the early stages, with the help of family members who can volunteer their time helping impaired older adults with so-called “activities of daily living” like preparing meals, taking medications and keeping clean. But in time, as cognition declines, the care needs will typically exceed what family members can provide.
Some of the programs provided through Medicaid are designed to allow impaired older adults to stay in their homes. The Medicaid Waiver Program can pay for caregivers to help in the home, and the Medicaid PACE program can provide care outside the home during the day.
At times, even with family help and government programs, care can no longer safely be provided in the home, and families look for institutional care options like nursing homes and assisted living facilities. Choosing a facility involves understanding care needs of the individual as well as the financial component, and which government programs may be available to assist. At CT we have both lawyers and social workers for exactly this reason.
POAs and Guardians
Then there’s the question of who can make a decision on behalf of the impaired older adult. Whether estate planning has been done and done appropriately, or whether the older adult is still “competent” to create new documents, such as a power of attorney, or patient advocate designation is often another issue. While alternative like guardianships are available, they involve most cost and delays.
Attitude and Personality
Not to get lost in the process of planning for long term care are the unique traits of the elder involved. Some elders might enjoy the socialization that comes with placement in a care home, other might find the idea of being institutionalized the equivalent of a death sentence.
Growing old is tough. Some people are just more accepting of the indignities that go with the process of aging than others, and their capacity to adopt to new realities is often overlooked, but often also the most important component to successful planning.
