Long term elder care in the U.S. is essentially non-existent. Well, let me qualify what I mean.
It is essentially available if you self-pay (through ‘drawing down’ savings or assets) for as long as you can afford to pay.
Alternatively, if you live in poverty or at 138% of Federal Poverty Level or depending on the state in which you reside, the government through the Medicaid program – a type of co-op between federal and state pays for you. Of course, Medicaid may pay “for you” but reimbursement or indemnity by your estate is expected to recover some of those expenses.
Lastly, Medicare imposes restrictions on coverage and doesn’t pay for a private room nor services in assisted living. Medicare was designed to cover only doctor visits (acute care). Hospitalization was historically governed by the “improvement” standard with care discontinued when it was determined the patient was not expected to improve. A lawsuit, Jimmo v. Sebelius resulted in a settlement, as approved on January 24, 2013 which removed the necessity for patient improvement. Now, patients can obtain the 100 day of hospitalization when the need for skilled care is required for maintaining the status of the patient whether or not the condition of the patient is expected to improve (improvement is a true sign of “short term” need). Medicare stops paying for all in-bound skilled certified nursing facility after the first 100 days. Under Medicare, the first twenty (20) days of those are covered at 80% with the rest of the time covered at decreasing rates!
There are three options for long term care. First, there is Assisted Living or care outside the home for those who can still manage to do self-care. Assisted Living costs on average $3,022 per month for a private one bedroom apartment. Secondly, qualified skilled Nursing Home Facilities (NHF) provide the maximum care but can cost $7,000 or more per month. The last option is In-home care when assistants visit the home to help with caring for an in-bound loved one. Medicare will pay for part time or intermittent in-home care as long as your doctor agrees it is “medically necessary” and orders the service. AskMedicare is a service that provides information to care givers (http://www.medicare.gov/files/ask-medicare-care-for-others.pdf).
What happened? THERE IS NO MIDDLE GROUND! A fiscal and social crisis based on demand for long term care is at our door!
Private long term care insurance should be considered and purchased around the age of 50. Estate and long term planning…. consider a subscription to Educational Family Estate Apps. At $69, it is a gift which gives valuable information all year long!
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