Long-term Care Planning for Seniors

Planning Ahead for Long-term Senior Care

Living longer lives comes with a need for planning for long-term care. When Medicare was created a little more than 50 years ago, life expectancy in the U.S.A. was age 75. As we live longer lives, we also will need caregiving services usually for at least a couple of years when we become the "oldest old", over age 85. Medicare provides for healthcare benefits for seniors but does not pay for long-term care services beyond emergency rehabilitation care up-to-100 days in a nursing home only. Seniors who qualify as very low-income without assets can qualify for Medicaid which will pay for long-term care in a nursing home and part-time care in the home. 

How to Plan for Long-term Care for Seniors

Senior caregiving needs will often arise quickly, after a sudden diagnosis for an age-related illness, a fall, or an incident that showcases memory loss. As Americans are living longer lives, more seniors are beginning to research senior care options to plan ahead for both the financial needs and caregiving needs for successful aging.

What is long-term care planning?

The term long-term care could cover a lot of different needs, but the phrase has become the description for planning for both caregiving services and financial needs as we age. As medical care has advanced, we are able to now have surgery to add a pacemaker when our heart is not beating fast enough, unblock a clogged artery and even replace hips and knee joints. All of these advancements allow us to live longer lives while needing caregiving services to assist us to recover from a major medical incident or just to help out with our activities of daily living (called ADL's) as we journey through the natural progression of aging. 

Memory loss also can come with aging, with seniors over age 85 suffering at least some memory loss and those diagnosed with Alzheimer's disease progressively losing their memory. This makes it vital to plan for long-term care before you need it.

Who is long-term care for?

Seniors plan ahead for caregiving needs for when they may be unable to care for themselves. Care needs may be temporary, for assistance recovering after major surgery, or long-term, meaning ongoing care because capabilities are declining. For example, a senior may suffer a stroke and lose their ability to speak or walk and have the opportunity to regain some of their abilities while needing caregiving services. Memory loss also requires ongoing care services, or long-term care, especially for Alzheimer's disease which is a progressive disease, continuing to take over more and more of someone's mental abilities to clearly communicate. Our former president, Ronald Reagan, had Alzheimer's disease and had the luxury of receiving long-term caregiving services and remaining in his home, even when he became unable to speak. When a long-term care plan is in place, family members and loved ones will know the senior's preferred type of care and ability to pay for the care services.

Finances are as important as care choices and must be discussed first when doing long-term care planning. How much monthly income does the senior have coming in? How much money has been saved? Does the senior live in a home that has been paid for or do they still pay on a mortgage for the home? Long-term care financial planning will outline both the senior's assets and the costs of care.

Care location then should be considered. A long-term care plan will include choosing if the senior would like to age-in-place in their own home or would like to relocate to an adult child's home or to an Assisted Living Community. Sometimes seniors will decide to sell their home and relocate to a senior living apartment complex or senior community. The Villages in Florida began the trend for communities that provide everything streamlined for seniors, including hospitals and nursing care centers along with golf courses and entertainment complexes. 

Medical needs are also part of the long-term care considerations. How close to a quality hospital does the senior live? Should they relocate to be closer to medical doctors for any special medical conditions? And, what medical assistance do they not want to accept if they lose some capabilities? The book by Atul Gawande, titled "Being Mortal and What Matters in the End" provides a quick and entertaining read. The book gives examples of how our bodies and minds change as we age to help us think ahead to create the ideal long-term care plan for ourselves and our loved ones. 

Power of Attorney documents will be discussed as part of a well-created long-term care plan. Medical emergencies such as a stroke or heart attack can happen suddenly. Medical staff must follow privacy guidelines that have legal consequences established by HIPAA, the Health Insurance Portability and Accountability Act. As a senior may not be able to communicate or could have memory loss issues, the Power of Attorney and HIPAA authorization forms make sure the senior has someone they trust in place for medical care decisions.

Socialization needs should also be discussed when planning ahead for long-term care. Some people are social butterflies and others are introverts. However, research shows that successful aging includes having an active network, or community of friends and a regular schedule of activities to engage in with others. Part of thinking ahead for long-term care needs includes accepting that a senior's peers may die before they do. Many seniors who are in their 90's have outlived their siblings and friends. How will they be able to maintain an active community of friends and activities? Technology allows us to more easily connect with loved ones but still does not replace in-person socialization. Senior living communities have expanded to offer services that would be similar to resort living and deliver the added benefit of having regular activities and can be a solution for senior's who might become isolated as they outlive loved ones.

Memorial services now can also be preplanned. As the saying goes, nobody gets out of this alive. Long-term care planning can also discuss a memorial service or life celebration service.

Estate plans or wills should also be confirmed as part of making long-term care plans. It's important to discuss the costs of senior care if they are required around the clock as this could require more money to be spent on care. Updated look-back laws for qualifying for the low-income Medicaid senior care program make it much more difficult for a senior to give away assets in order to qualify for Medicaid. Many adults remember grandparents or aunts and uncles who gave away money and then went onto Medicaid services but it is no longer possible to do that. However, a senior may spend down their assets to qualify for Medicaid. An elder care attorney will be able to assist in this part of the senior's long-term planning.

Long-term Care Planning Checklist

  • Finances: monthly income and savings
  • Location: age-in-place in-home or prefer to move or need to move?
  • Medical Services: ability to easily travel to medical doctors, rehabilitation services, and hospitals
  • Power of Attorney Documents: establish P of A for Healthcare and Finance and HIPAA permissions
  • Socialization: what happens if a spouse or close companion dies?
  • Memorial Service: funerals or memorial service plans
  • Estate Plan or Will: confirm an estate plan or will has been created and updated

These are the essentials for long-term plans to meet all the necessary needs in an emergency. Talking about money, legal documents and lifestyle changes after friends pass away are all constructive ways to plan ahead for senior care. Long-term care planning tools can be used to take the emotion out of the discussion and assist families to focus on the legal requirements, financial considerations and care needs for the long-term care plan. Professional care managers can also be hired as a long-term care guide.

Signs Someone May Need Long-term Care

Planning ahead for long-term care will make it much easier for loved ones to know a senior's wishes if an emergency care situation arises. However, sometimes a senior does not realize they need care. Seniors experiencing memory loss will many times not realize they need assistance. There may also be fear around losing independence or about the costs of care. Planning for long-term care for a man may be different, of course, than planning for long-term care for a woman and thought should be given to a scenario where one or the other of a spouse passes away. The importance of planning ahead for couples makes it much easier to consider how the long-term care needs will change based on which spouse outlives the other. 

Long-term care plans for seniors enable them to be in control of their care and confident they will receive the care of their choosing.

Long-term Caregiver Responsibilities

Caregiving services will provide companionship, assistance with Activities of Daily Living (ADL's) and escorting to medical appointments along with transportation and housekeeping.

How to Plan for Long-term Care Financially

Senior care service costs vary widely, depending on if the care will be provided in the home, in an assisted living community and as temporary respite care or as long-term care (ongoing).

Also, adult children or grandkids may be able to assist with the care. Hourly care will include payroll costs and insurance protections as well as a care manager for caregivers hired through licensed senior home care agencies. Assisted living communities usually suggest having at least $2,500 per month available for rent plus additional funds for care services when the need arises.

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