Introduction...
All of us have to face the uncomfortable fact that, one day, we or our family members may need some kind of expensive long-term care. Most older people, even if they remain basically healthy, develop physical or mental frailties or impairments that at some point prevent them from living completely independent lives.
More than five million older people in the United States receive some form of daily care at home, provided by someone from outside the family. Millions more receive regular care, though not on a daily basis. And still more millions receive at-home care entirely from family members -- who may not be able to continue that care indefinitely. Nearly two million people over age 65 live full-time in some type of nursing facility or other residential care facility, at a cost of between $30,000 and $150,000 per year. Of people over 65 in nursing facilities, about 25% will live there for longer than a year and about 10% for more than three years.
Medicare, which some believe pays for medical care for everyone over 65, in fact pays for only about 10% of all nursing facility costs, a smaller fraction of all home care costs and nothing at all for long-term care. Medicaid, the federal government program which pays medical costs for the financially needy, pays for about half of all nursing facility costs, but you have to spend most of your personal assets before you become eligible for coverage. And while Medicaid pays for residence in a few assisted living, shelter care or residential care facilities, most of this cost must be paid with private funds.
These statistics convey an urgent, unsettling message: Many of us will need long-term care -- and the government is not going to foot much of the bill. This book can help you prepare for what the future might bring by presenting the alternatives you need to consider. The more physically, emotionally and financially prepared you are, and the more in control of your own life, the better off you and your family will be.
A. What Is Long-Term Care?
As used in this book, "long-term care" means regular assistance with medical care (nursing, medicating, physical therapy) or personal needs (eating, dressing, bathing, moving around) provided by someone outside an older person's family. There are many varieties of long-term care -- ranging from part-time home care and adult daycare, to independent living and assisted living residential communities, to personal care residences and nursing facilities. Some long-term care is temporary -- for example, just long enough to help an older person recover from a broken hip or a stroke. Often, though, once begun it lasts for the remainder of an older person's life.
B. Complex Questions of Long-Term Care
An older person's debilitating condition may be only partial -- such as failing hearing or eyesight, memory loss or weakness in arms or legs. Or it may be extreme -- the effects of a major stroke or heart ailment, overall frailty, the later stages of Alzheimer's disease. Whatever the specific nature of the impairment, you will have to face a number of difficult questions:
What kind of care is needed?
Who will provide it?
Where will it be provided?
How much will it cost?
Who will pay for it?
Attempting to answer these questions will require you to negotiate a number of minefields: finding the right level and amount of care, avoiding unnecessary institutionalization, understanding complicated Medicare and Medicaid rules, considering private long-term care insurance -- and importantly, paying for the high cost of care without losing every cent you have.
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