If you are age 65 or older, care for someone who is, or anticipate becoming a mature American yourself, then you are in good company. According to the U.S. Census Bureau, Americans age 85 and older are the fastest growing demographic group and, right behind them, 79 million baby boomers are moving into retirement age themselves.
However, with advances in age come advances in health issue. Along with health challenges, there are special legal challenges that arise. The body of law addressing these challenges is commonly known as "Elder Law" today.
Generally speaking, Elder Law can be defined as the holistic application of general legal principles to the specific emotional, logistical and financial needs of mature Americans. Many of these Americans are concerned with two fundamental threats to their dignity: (1) becoming incapacitated, and thereby losing control over their personal, health care and financial decisions; and (2) running out of money due to the catastrophic costs of long-term care. Fortunately, these threats may be minimized, or even avoided, through properly coordinated legal and financial planning.
As the number of birthday candles increase on your birthday cake, so do the odds of becoming incapacitated due to an injury or illness. Whether incapacity strikes suddenly or over time, the consequences are the same. Either you will have properly appointed decision-makers of your own choosing through legal planning in advance, or the courts will appoint a conservator for you under the ongoing supervision of the court. The pre-planning alternative is less expensive, easier on your loved ones and protects your privacy from the public record.
According to commonly cited statistics, if you are age 65 and single, then the odds are about 50 percent that you will need long-term care at some point. For married couples, odds are about 75 percent that one spouse will need such care. For how long you may ask? The average stay runs about two and a half years.
Nationally, a year in a nursing home is estimated to cost an average of $90,000. Little wonder 50 percent of married couples with one spouse in long-term care are impoverished within one year of admission. For singles, that percentage jumps to 70 percent.
You may be thinking, "I have Medicare, so I don’t have to worry about long-term care, right?" Unfortunately, such is not the case. Medicare only pays for acute nursing home care, not chronic care. Think of acute care as rehabilitation after hip surgery; You will be going home to care for your own daily needs. Think of chronic care as needing help with “activities of daily living” like bathing, eating, dressing, continence, toileting or transferring issues as a result of increased frailty and even dementia. Even for acute care in a skilled nursing home, Medicare will only pay for up to 100 days with strict eligibility requirements and full payments are limited to the first 20 days with patient contributions required thereafter. By the way, your Medigap (i.e., Medicare Supplement) policy will not pay for your long-term care, but may pay the Medicare co-payments for days 21 through 100.
While Medicare is solely a federal program, Medicaid is a joint state-federal program. Each state operates its own Medicaid system which in Tennessee is called “TennCare.” Nonetheless, all Medicaid programs must adhere to federal guidelines to receive federal funds. Federal money pays for half the state’s Medicaid costs, and the state pays the rest. There are strict income and asset guidelines that must be satisfied to be eligible for Medicaid coverage.
Legally speaking, any transfer of assets for less than fair market value (i.e., a gift) may subject you to a lengthy period of TennCare ineligibility under a complex and confusing web of regulations. Nevertheless, as with most areas of life, proper planning is rewarded and the failure to plan is not. Through proper Medicaid planning, you may be able to legally qualify for Medicaid and protect your assets for yourself now and your loved ones later.
If you are in good health and can pay the premiums, long-term care insurance (LTC or LTCI) is another means to pay for your care. In addition, long-term care insurance is sometimes used in conjunction with Medicaid legal planning to pay for care during a period of potential ineligibility.
No one likes to think that he or she may become incapacitated and may need expensive long-term care in the future. However, denial and avoidance is not a strategy, and there is no time like the present to plan. A debilitating illness or injury could strike any of us at any time. When you are ready to explore your options, contact us to schedule an initial consultation.