Planning For Long-Term Care
How can I plan for long-term care?
As far as how you or I or anyone else can plan for long-term care, I would say the biggest and most important thing to do is plan on amassing a whole lot of assets. Long-term care is quite expensive. Probably the lowest price is generally going to be at least $2,000 a month and there is a lot of variability from state to state. In a nursing home, it would be more like $4,000 a month or more, and so you can burn up quite a bit of assets pretty quickly. Thinking about long-term care insurance is certainly something that should be considered and also knowing what your family resources are and what the expectations are can be helpful.
How do I prepare financially for long-term care?
As far as how to prepare financially for long-term care, it's a difficult question because it can be very expensive and none of us anticipates being severely ill or chronically ill with a lot of care needs for many years, but unfortunately some of us do wind up in that mode. I think long-term care insurance is one thing that can be considered. This should be considered when you are younger as when you buy it, the less expensive it is but it is just good asset management, I think considering some of the health savings accounts that are now available under the tax code are things that can be considered. But again, long-term care can be extremely expensive and a lot of assets can be burned up that way. Also, for people who don't have a lot of assets, certainly Medicaid is a good way to go, assuming that the money stays there. If you are indigent, you can get Medical or Medicaid to pay for long-term custodial care, although they will only pay for it in a skilled nursing facility. They won't pay for it at a lower level of care as of now. That may be changing.
How do I prepare legally for long-term care?
As far as preparing legally for long-term care, I would say talking to a legal advisor of some kind. Also, talking to family members and so on. It doesn't have to be anything super expensive, but it is good to have at least a durable power of attorney at least for health care, assuming that you have somebody you trust to make the decisions that need to be made. It is important to discuss with your family and loved ones, or your decision makers, or if you have an attorney or legal counsel, exactly what your wishes are as far as long term care.
How do I choose the best long-term care situation for myself?
As far as how you choose the best long term care situation for you or for a loved one, I think talking to people is probably the best way to do it. Talking to people who work within our industry as well as talking to people that you know who have had contact with it. I think word of mouth is very important because from one community to the next, there is a very wide variability. So I think that's probably the best way to find out what's available in your area and what would best suit your needs and obviously getting out there and actually seeing those places that you are considering and if it's an option to get care in your home. I think a great majority of us would choose that option as supposed to going to a new unfamiliar place with, you know, strangers taking care of you essentially.
How do I choose the best long-term situation for my parents?
As far as choosing a long-term care setting for our parents, that is a difficult task because we may have one opinion and they may have a totally different opinion, but obviously it should be their choice. So I think going around seeing the kinds of places that are available in the community and of course matching it up with the resources that are available, as far as financially, whether they can afford it or not or what other types of coverage they might have and discussing with people in the community. A lot of times there may be geriatric case managers that can help. There are also agencies and private individuals who are very familiar with the various settings in the community who could probably pick a handful and have you go out and visit those. So I would encourage you to do that with your parents if you are thinking about placing them.
Why is discussing long-term care with my parent so hard?
It is very hard to discuss long-term care with parents, because, what it means is they are giving up some of their independence and they are going to be transitioning from an independent community setting, maybe a house where they have lived for the last forty years and moving to a place where they are going to be increasingly dependent on others. They may not be able to drive anymore and it is traumatic, it is traumatic for everybody but especially for them. It is just a tough conversation, it is the kind of conversation that at certain times, you will just get a "We're not talking about that, it is not happening, I flat out refuse", and yet sometimes their safety is at risk and so it is just the kind of thing that you need to insist upon.
What can I say when my parents want me to promise they'll never be 'placed' in a nursing home?
If your parents tell you, "No matter what happens, promise me you'll never put me in a nursing home", you cannot make that promise. You just need to tell your parents, "That is not a promise I can make". I will do everything I can within reason to keep you in a home setting as long as you can, but there are things that we can't foresee. I don't want to make a promise that I might have to go back on someday and then spend the rest of my life feeling guilty about because you, Mom or Dad, had to spend your last six months in a nursing facility. Because your care and needs were far beyond what I could provide at home or any of the grandkids or anyone could provide at home. So don't fall for that and whatever you do, don't make your kids make that promise to you. It's a truly unkind and toxic thing to do.
What if I can't provide the long-term care my parents need?
If you're a care giver and you've been caring for your elderly parent, parents at home or in their own home and you're starting to burn out, you're in good company. That's a very common situation and probably more common when there's dementia involved, because that's exceedingly stressful. I would say, if you wind up having some kind of break down or if you get to the point where you're so irritable that you just snap or do unkind things to your parents, that is no longer being helpful to them, and so sometimes the sad reality is that we cannot care for our parents in a home setting. Before you get to the point of just having a break down or having some bad outcome happen, start thinking about long-term care. There are other options. There's also, day care, and adult day care. There are a whole lot of other resources that are available. But just don't let it get to the point where you're really at the end of your rope. It's a very difficult task to care for parents at home.
Why does the thought of my parent in a long-term care facility make me feel so guilty?
The picture that Americans have in their mind of the nursing home is not a pleasant place. When you think, I have to put my parents in one of those places, number one you think, "well, we are warehousing them, we are just waiting for them to die." At some level this may be true, but they are not terrible places. Sometimes that is just the reality. People have their own lives, they are not able to devote their entire life to taking care of their parents, as much as they might like to do that. Also, people feel guilty because they feel that they are failing, that they are not able to do what is expected. That still happens in many other cultures as far as caring for your parents. I think our parents took care of us when we were little and we feel like we owe them. Of course, we do owe them, but there is a limit as to how much can be done.