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  • Writer's pictureKaren McPhail, RN, MSN

Paying for Assisted Living and More: A Growing Problem!

Many individuals despite planning and saving, still do not have enough funds to meet their care and quality of life needs later in life. I often receive frantic calls from families desperate for help as they are running out of funds. They desperately seek to have their family member in assisted living where they can have better quality of life and age in place versus a traditional skilled nursing home under medicaid. This is not an easy or straight forward process. The path is often times unpredictable and one that has to be approached carefully. The sad reality is that approximately 70 percent of Americans 65 and older will require long-term care of some kind, according to a study by the U.S. Department of Health and Human Services. So, how does one navigate this growing problem?

Here are some strategies and steps to consider when planning:

Early on: (in your 50's)

1. If early in the process explore the purchase of long term care insurance if you are able to afford to due so. Look for a policy with long term coverage that will assist with your care needs whether at home, in assisted living or in skilled nursing facility. Proceed slowly and with guidance from a trusted financial planner or a Geriatric Care Manager to ensure that you get what you really need at a cost that will be manageable.

2. Meet with a financial planner to discuss realistic goals and a distinct plan for the future.

3. Consult an Elder Care Attorney! This is critical to obtain guidance for the future and to have a point person going forward as your needs change.

4. Try to ensure transparency of information within your family to prevent any conflicts later. Decision makers need to understand your wishes clearly.

Closer to:

1. Still do your best to stick to your plans and adjust items with your elder care attorney and financial planner as needed. Seek guidance and support from a Geriatric Care manager regarding relocation and ongoing care management. If the goal is assite3d living or a continuing care community, ensure that you enter with at least two years of funds if possible. Do not wait until you are almost out of funds as the process will become more difficult and stressful.

2. If wanting to age in place speak with your local agency on aging, ask about any local subsidy programs and explore programs such as PACE which provide assistance for those wanting to remain in their homes and age in place. PACE is a Medicare and Medicaid program that helps people meet their health care needs in the community instead of going to a nursing home or other care facility. PACE stands for Programs of All-Inclusive Care for the Elderly. PACE can provide assistance with home care, transportation, dentistry, prescription drugs, and more. You can have either Medicare or Medicaid, or both, to join PACE. PACE is only available in some states that offer PACE under Medicaid. To qualify for PACE, you must: • Be 55 or older • Live in the service area of a PACE organization • Need a nursing home-level of care (as certified by your state) • Be able to live safely in the community with help from PACE

3. If you feel that funds are going to be an issue down the road look for assisted living facilities where you can age in place and that participate in the auxillary grant program. Or if looking at a continuing care community, access one's that will accommodate a transition to skilled nursing and medicaid if needed later. Facility lists are online for access. Even if you are approved for an auxillary grant or traditional medicaid the facility will still need to have a bed and rooms will be offered at their discretion. There are no guarantee ever made by facilities in advance!

4. Access veteran's 's programs if appropriate! The Veterans Administration's Aid and Attendance is part of the improved pension benefit that is often times not known by or accessed by many. Aid and Attendance is an enhancement to a veteran's regular VA pension. As of 2017, an eligible veteran may receive up to $1,794 monthly, a surviving spouse is eligible for up to $1,153 monthly, and a veteran with a spouse is eligible for up to $2,127 monthly. Remember to access all benefits that you are eligible for!

5. Creative financing options can also be explored, however I view this as a last resort through: Bridge loans, reverse mortgages, annuities, life settlements, etc. I recommend using extreme caution when going down this path! Remember, before taking risks with investments and assets, such as this, as this is a risky and major financial decision, you need to speak at length with a trusted, financial advisor.

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