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Odds you will live out your last years in a SNF?

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More On Medicaid Elder Care

Rick Kahler MS CFP

By Rick Kahler MSFS CFP®

If you’ve ever visited someone in a nursing home, chances are you walked out afterward vowing, “I’m never going to end up in a place like this.” That vow is one most of us would make. Keeping it, however, is another matter.

Let’s consider some facts

What are the odds you will live the last years of your life in a skilled care facility (nursing or assisted living home)?

About 14 percent of all people over age 64 have two to three chronic conditions that negate their ability to live independently. According to the U.S. Bureau of the Census, 5 percent of people over age 65 live in nursing or assisted living homes and 25 percent of them will spend some time in one. The chance of a stay in a nursing home increases 1.4 percent a year from age 65 on. Almost 50 percent of those over age 95 live in nursing homes.

While staying in the comforting surroundings of our homes is what most of us would prefer, just saying so isn’t going to make it happen. Unless you have a written plan and the finances to carry out that plan, the chances are high you will not be able to afford living in your home once you need daily assistance of some type.

The problem is that spending your last years in a nursing home is expensive, too. At rates of around $7,000 to $12,000 a month, it is very easy to spend $250,000 or more during the last years of one’s life. While this is doable if you have the money, it becomes a financial disaster if you have a spouse and spend through your estate in your last years. In this case, the first one to die wins at the expense of the survivor.

More U.S. Census Bureau Data

According to the U.S. Census Bureau, 70 percent of Americans age 65 and over have a household net worth of just $344,870. If one spouse enters a skilled care facility there is a real threat that the other will run out of money to fund living expenses, relying only on Social Security.

Once someone’s assets are spent down, Medicaid will begin paying for nursing home costs. This may mean changes such as moving to a facility that accepts Medicaid and out of a private room into a shared room. It also may mean waiting for a bed to become available.

***2016-CRS_Fall_Hourglass_6-14_hero

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The Short Version

The “short version” of the law is that Medicaid begins paying once assets are spent down to $2000. However, there are provisions meant to protect the non-institutionalized spouse from destitution. Some of the couple’s assets are exempt from being spent down for nursing home care.

Example:

In South Dakota, for example, the spouse may keep half of the combined assets up to $119,220. Other exempt assets generally include personal possessions, one vehicle, equity up to $552,000 in the couple’s personal residence, prepaid funeral plans, and assets that are considered “inaccessible”. There are also limits on monthly income from pensions. The numbers above are for South Dakota; all of these limits vary by state so be sure to research your own state’s laws.

Assessment

Obviously, planning for long term care is vitally important, and it needs to be done well before the event that sends someone to a skilled care facility. Unfortunately, those events are often sudden and impossible to predict. The sad reality is that very few people plan ahead—even those who do financial planning in other areas. Many elders have a deep resistance to doing end-of-life planning.

That is sad, because the less planning you do, the more limited your options become. 

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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***

On Elder Safety and Frugality

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Spending Money for Comfort and Safety

By Rick Kahler MS CFP® http://www.KahlerFinancial.com

Rick Kahler CFPWant to increase your independence in retirement? Save money? Live safely in your own home? Then buy a new car. No, this isn’t a scam or a seedy sales pitch. In certain cases, a new car can be a wise use of your retirement dollars.

Introduction

As regular readers of the ME-P know, I’m a big fan of frugality. Spending less than you earn is a crucial strategy for building wealth. Continuing this frugal lifestyle in retirement can also be a good way to be sure of having enough money to last for the rest of your life.

Some retirees, though, take it too far. Under-spending can be a threat to retirement as much as overspending, especially when it affects your comfort and safety.

As more of my retired clients move into their later years, I am becoming increasingly aware of one kind of retirement spending that can actually be considered more of an investment than an expense. This, for elderly people or adult children caring for elderly parents, is spending money to make their homes and activities safer.

Safer Spending

One immediate benefit of this kind of spending is being able to live more comfortably and with less anxiety. A second benefit is financial. Helping elderly parents stay in their homes and live independently for as long as possible can save money in the long term by reducing medical costs and long-term care expenses. It’s especially important to invest in this type of spending if you live too far away from your parents to provide regular help yourself.

Some of the ways to invest relatively small amounts to provide more comfort, safety, and independence for elderly parents are obvious. Or, carpet slick tile or hardwood floors to reduce the risk of falls. Upgrade older appliances to newer ones with safety features like automatic shutoffs or warning signals. Add basic safety aids like stair railings and shower bars. Repair hazards like worn carpets, uneven steps, or broken sidewalks. Provide emergency alert buttons. Install phones in several rooms.

Other Considerations

Some less obvious ways to foster safety and extend independent living might require a bit more spending. Such expenditures can be a good use of retirement income if they extend parents’ ability to live independently. Here are a few possibilities to consider:

1. Buying that new car. Safety features like GPS navigation systems and backup cameras can allow elderly people to hold onto their drivers’ licenses longer without putting themselves or others at risk.

2. Paying for gym memberships or exercise classes. Increasing strength, balance, and flexibility can help prevent falls and possibly even help stave off dementia.

3. Taking care of ears and eyes. Hearing aids and corrective lenses may not be cheap, but good hearing and eyesight can help people drive more safely, avoid falls, and take care of themselves and their homes.

4. Remodeling. Moving the laundry room to the main floor or replacing bathtubs with walk-in showers can make homes safer and more comfortable.

5. Hiring help. Many of us equate in-home help for the elderly with home health care. Certainly, hiring aides to help with cooking, bathing, and other needs as people become frail is an important option. But well before that time, it makes sense to get help with a host of other services that become harder or even dangerous to do as we grow older. Hire a house cleaner. Find someone to do yard work, home maintenance, and heavy cleaning jobs (especially if they involve ladders) like window washing.

***

Elder

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Assessment

Spending that creates safety belongs in any retirement budget. It’s a good way to use your financial independence to help maintain your physical and mental independence.

Conclusion

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The Elderly Population is Exploding

Yet, Nursing Homes are Closing!

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Here is a visually compelling graphic that covers the rash of nursing home closures that have been occurring since 2008 across theUnited States.

Even in the face of a ballooning Boomer and elderly population and the ACA, nursing homes are closing, and minority areas are feeling the brunt of it.

What gives?

Source: assistedlivingtoday.com 

Conclusion

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Long-Term Care Insurance

A Review for Doctors and Advisors

By Gary A. Cook; MSFS, CLU, ChFC, LUTC, RHU, CFP®, CMP™ (Hon)

insurance-book6

Long-term care (LTC) insurance is considered one of the newest forms of personal coverage insurance.  LTC insurance is designed to transfer the financial risk associated with the inability to care for oneself because of a prolonged illness, disability, or the effects of old age.  In particular, it is designed to insure against the financial cost of an extended stay in a nursing home, assisted living facility, Adult Day Care Center, hospice or home health care.  It has been estimated that two out of every five Americans now over the age of 65 will spend time in a nursing home.  As life expectancy increases, so does the potential need for LTC. One unfortunate consequence of being the “new kid on the block” is the lack of actuarial data specifically collected for this style of policy.  This results in policy premiums being underpriced to sustain the claims currently being experienced.  During the first half of 2003, at least three insurance companies stopped writing these policies because of their losses.  Those insurers remaining in this market are expected to increase premiums quickly.  Unless these policies can be profitable for the company, their future will be an uncertain one.

Medicare

Any discussion of LTC must begin with an understanding of what Medicare is designed to cover.  Currently, the only nursing home care that Medicare covers is skilled nursing care and it must be provided in a Medicare-certified skilled nursing facility.  Custodial care is not covered. Most LTC policies have been designed with these types of coverage, or the lack thereof, in mind. To qualify for Medicare Skilled Nursing Care, an individual must meet the following conditions: 

  • Be hospitalized for at least three days within the 30 days preceding the nursing home admission;
  • Be admitted for the same medical condition which required the hospitalization; and
  • The skilled nursing home care must be deemed rehabilitative.

Once these requirements are met, Medicare will pay 100 percent of the costs for the first 20 days.  Medicare covers days 21 to 100 along with a daily co-payment, which is indexed annually.  After the initial 100 days, there is no additional Medicare coverage. Medicare Home Health Services cover part-time or intermittent skilled nursing care, physical therapy, medical supplies and some rehabilitative equipment.  These are generally paid for in full and do not require a hospital stay prior to home health service coverage.

biz-book

Critical LTC Policy Features

According to the U.S. Department of Health and Human Services and the Health Insurance Association of America, there are seven features that should always be included in a good long LTC policy: 

  • Guaranteed renewable (as long as premiums are paid, the policy cannot be canceled).
  • Covers all levels of nursing care (skilled, intermediate and custodial care).
  • Premiums remain level (individual premiums cannot be raised due to health or age, but can be raised only if all other LTC policies as a group are increased).
  • Benefits never reduced.
  • Offers inflation protection.
  • Full coverage for Alzheimer’s Disease (earlier contracts tried to eliminate this coverage).
  • Waiver of premium (during a claim period, further premium payments will not be required).

In addition, there are another seven features considered to be worthwhile and are included in the better LTC policies: 

  • Home health care benefits
  • Adult day care and hospice care
  • Assisted living facility care
  • No prior hospital stay required
  • Optional elimination periods
  • Premium discounts when both spouses are covered
  • Medicare approval not a prerequisite for coverage.

ADLs

Most LTC policies provide benefits for covered insured’s with a cognitive impairment or the inability to perform a specified number of Activities of Daily Living (ADLs). These ADLs generally include those listed below and the inability to perform two of six is generally sufficient to file a claim:

1. Bathing:  Washing oneself in either a tub or shower, or by sponge bath, and includes the task the getting into and out of the tub or shower without hands-on assistance of another person.

2. Dressing:  Putting on or taking off all necessary and appropriate items of clothing and/or any necessary braces or artificial limbs without hands-on assistance of another person.

3. Toileting:  Getting to and from the toilet, getting on and off the toilet, and performing associated personal hygiene without hands-on assistance of another person.

4. Transferring:  Moving in and out of a bed, chair or wheelchair without hands-on assistance of another person.

5. Eating:  The ability to get nourishment into the body without hands-on assistance of another person once it has been prepared and made available.       

6. Continence:  The ability to voluntarily maintain control of bowel and/or bladder function, or in the event of incontinence, the ability to maintain a reasonable level of personal hygiene without hands-on assistance of another person.

Other Issues

Another issue concerning ADLs is whether the covered insured requires “hands-on” assistance or merely needs someone to “stand-by” in the event of difficulty.  Obviously, LTC policies that read the latter are considered more liberal.

fp-book1

Long-Term Care Taxation

Some LTC policies have been designed to meet the required provisions of the Kassenbaum-Kennedy health reform bill, passed in 1996, and subsequently are “Tax Qualified Policies”.  Insured’s who own policies meeting the requirements are permitted to tax deduct some of the policy’s premium, based on age, income and the amount of total itemized medical expenses.  The major benefit of the tax-qualified LTC policy is that the benefit, when received, is not considered taxable income.  There are several initiatives in Congress, however, which would expand and simplify these deductibility rules. 

Assessment

Regardless, the medical professional or financial advisor [FA] should investigate the opportunity afforded them through their current form of business, or client use, for any purchase of a LTC policy. And, small businesses may be permitted to deduct LTC premiums on a discriminatory basis.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. What have we missed, and who might wish to update this post?

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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Selecting an Assisted-Living Facility

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Checklist for Financial Planners

[By Staff Reporters]

Thousands of boarding homes cater to the elderly. Their operators promise to provide at least a place to sleep and food to eat. Beyond that, the services and assistance offered will vary from facility to facility. This checklist will help the financial planner or his or her client find a facility that is appropriate in all respects to the client’s resources and needs. Unlike nursing homes, assisted-living facilities often operate without any scrutiny from public agencies. Furthermore, Medicaid often will not be a source of funds.

The Checklist

The items the financial planner and client should consider when selecting a facility are listed below.

      1.   Determine the client’s willingness to live in a group environment.

      2.   Avoid unlicensed facilities, particularly if Medicaid-provided services may be needed in the future.

      3.   Review the facility’s inspection report.

      4.   Review the facility’s service contract and house rules. Look for answers to the following questions:

            a.         Where will the resident live?

                        Are there any types of ownership rights?

                        What flexibility is there with respect to furnishings?

                        Will the same unit be available after a hospital stay?

            b.         What meals are included?

                        Will the facility provide appropriate meals and a special diet?

            c.         What form of transportation does the resident currently use?

                        What transportation is provided by the facility?

                        Can residents shop, dine, attend services or visit doctors?

            d.         What help does the facility provide during a medical emergency?

                        What type of staff training is provided or required? Is there 24-                        hour-a-day staffing?

            e.         What provisions are there for privacy? When are rooms cleaned and when can staff access the rooms?

            f.          What is the basic cost and what are the costs for extras?

                        What is included in each?

                        What provisions for fee increases are there?

            g.         Can a resident see his or her own doctor?

                        Does the facility offer transportation for appointments?

            h.         Who’s in charge of administering and scheduling medication?

                        Can medication and other supplies be purchased at the facility?

            i.          What happens if the resident’s health begins to fail?

                        Does the facility provide additional services to help with ADLs?

            j.          What is the procedure for transfers from one unit to another?

                        Does the resident have any opportunity to express an opinion?

            k.         What’s required if a contract is terminated by facility or resident?

                        What is the provision with respect to refunded fees?

                        Is there a required minimum stay?

Assessment

What have we missed?

Conclusion

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Living Wills and Healthcare Proxies

Important  Issues for Financial Planners

By Dr. David Edward Marcinko; MBA, CPHQ, CMP™

By Hope Rachel Hetico; RN, MHA, CPQH, CMP™

dave-and-hope13Some current financial planning issues, for advisors are as follows: 

·         The constitutional right to refuse medical treatment is continually being challenged. The cases generally have been decided in favor of the patient. The law in this area is changing fast and bears watching.

·         Is the client competent to sign eldercare documents? It is best not to wait until the client becomes ill before making plans.

·         The intentions of the client must be ascertained and clearly stated in the documents, especially in the living will. The patient’s wishes must be clear and convincing, if they are to be followed. For example, if nutrition and/or hydration are to be removed from the patient’s healthcare, then this instruction must be clearly stated. Other special medical procedures may be required unless expressly excluded by the living will.

·         The determination of terminal and non-terminal conditions can be difficult. The directives of a living will usually apply to terminal conditions.

·         The professional responsibility to advise patients and clients of their alternatives is unclear. The legal liability of healthcare providers, and financial advisors, has been tested in courts with mixed results. For example, what is the liability of a provider that does not follow the directions of a living will?

·         With increasingly more complicated and sophisticated forms of medical treatment, the complete nature and scope of medical treatment and its effects are becoming more difficult to understand. Although medical professionals may be relied upon, in many cases the complete extent and nature of the treatment is not clear to everyone.

·         The effect of these relatively new healthcare powers on estate and property laws is yet to be determined. Do the property rights under a life insurance policy change, for example, if death is hastened by not doing all that is medically possible to sustain life?  This is especially germane if a policy has recently been issued and is within either the period of contestability or within the context of a suicide clause.

Assessment

What did we miss? With respect to these issues; the financial planner is well advised to stay abreast of the law in the state in which he or she practices and to consider these issues when making client recommendations. Otherwise, he or she should refer the client to a lawyer who does. Should financial advisors even become involved in this issue? If not – why not; and if so – to what extent?

insurance-book7

Conclusion

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