Protect Your Estate from Nursing Home Costs

Nursing home costs for care are expensive, costing between $12,000 to $20,000 per month, so most seniors should do all they can to prepare for this possibility. According to a recent article from the Times Herald-Record, “Elder Law Power of Attorney can save assets that would go to nursing home costs,” this is something that can be done even when entering a nursing home is imminent.

A Power of Attorney is used to name people, referred to as “agents,” to conduct legal and financial affairs, if we are incapacitated. Having this document is an important part of an estate plan, since it reduces or completely avoids the risk of your family having to go through guardianship proceedings, where a judge names a legal guardian to take over your affairs.

The guardian likely will be someone you have never met, who does not know you or your family. It’s always better to plan in advance, so you know who is going to be taking charge of your affairs.

Then there’s the Elder Law Power of Attorney, a stronger form of a Power of Attorney that includes unlimited gifting powers. Having this unlimited gifting power lets a single person who applies for Medicaid in a nursing home to protect their assets, by using a gift and loan strategy.

Here’s an example: Amy, who is single, can’t live on her own and even having home health care aides is not enough care anymore. She has $500,000 in assets and does not qualify for Medicaid to pay for her care. Medicaid will allow her to keep only $15,900.

One option is for Amy to spend down all of her money on nursing home costs, until all she has is $15,900. All of her savings will go to the nursing home, with very little left for her daughter, Ellen.

However, if Amy has an Elder Law Power of Attorney, a gift and loan strategy can protect her assets. Half of the money, $250,000, can go to Ellen as a gift under the unlimited gifting powers. The other half goes to Ellen as a loan, under a promissory note with a set rate of interest.

Any gifts made in the past five years, known as a “five year look back,” cause a penalty period. Amy will have to pay for the nursing home costs for about twenty months. Every month during that period, Ellen will pay Amy a monthly payment that, with her income, is used to pay the nursing home bill. At the end of the 20 months, Amy qualifies for Medicaid to pay for her care for the rest of her life, and Amy may keep the $250,000. Saving half of her assets by using the gift and loan strategy is sometimes called the “half a loaf is better than none” strategy.

With a Standard Power of Attorney, there are no unlimited gifting powers.

A Medicaid Asset Protection Trust (MAPT) created five or more years before Amy needed a nursing home could have saved her entire nest egg for Ellen.

Preplanning is always the better way to go. An elder law estate planning attorney is the best resource for determining what the best tools are to protect a nest egg if and when a person needs the care of a nursing home.

Many people make the mistake of thinking that it “won’t happen to me.” However, injuries and illnesses often accompany aging, and it is far better to plan for this eventuality in advance than waiting and hoping for the best.

DISCLAIMER: Medicaid planning is complex and the case hypothetical above with “Amy and Ellen” is provided for purposes of illustration. Whether this strategy would work for you or your loved ones depends on the laws of your state of residence given your unique circumstances. Consult with an experienced elder law attorney admitted to practice law in your state of residence before engaging in any Medicaid planning!

Reference: Times Herald-Record (Jan. 8, 2021) “Elder Law Power of Attorney can save assets that would go to nursing home costs”

 

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Helping Elderly Parents with Home Health Care

In some instances, it can be a very fast aging process from active senior to an elderly person who needs home health care . Their physical appearance or mental acuity may rapidly decline, and you may be certain that you need help to keep them living safely at home. However, for some, the deterioration may be gradual and more subtle.

Tapinto.net’s recent article entitled “Caring for Elderly Parents: Can They Live Safely at Home?” says that, no matter their physical and mental status, most seniors want to remain in their homes rather than move in with family or to a care facility. However, aging parents may require care to keep them safe and to manage their daily living activities. This responsibility frequently is given to the adult children, regardless of whether they are ready for this task.

If you’ve determined that your parent needs assistance to stay safe and independent at home, but you’re not sure if you and other family members can handle the caregiving responsibilities, here are some thoughts to help you. First, speak with your parents and help them realistically assess their living situation. Discuss all issues candidly and address any problems. Look at these specifics:

Safe living environment. Seniors are frequently injured in and around their homes by common hazards and poor lighting that cause falls.

Finances. Review the financial situation of your parents to be certain you understand all sources of income, assets and debts. Review the level of medical and insurance coverage. You should also see if each of your parents have a will, living will and power of attorney. Make sure that you know the location of these key documents. If they do not have these documents, help them find an experienced estate planning or elder law attorney to draft them.

Mental and physical health. See if your parents have any changes in their physical and mental health. Review the medications that your parents are taking and consult their home health care providers regarding any specific requirements. Make certain they have had basic vaccinations.

The ability of the family to provide assistance. Have a frank discussion with siblings and nieces and nephews about their ability to provide the level or kind of care that your aging parents need. Caring for elderly parents can be overwhelming. Know that you may need support to avoid caregiver burnout.  There are also professionals who can help your parents with activities of daily living (ADLs), personal care and companionship services. Home health aides or certified nursing assistants provide help with ADLs that may include assistance with:

  • Bathing, grooming, using the toilet and dressing
  • Meal planning and preparation
  • Light housekeeping, laundry and running errands
  • Medication reminders and picking up prescriptions
  • Hobbies and exercise; and
  • Companionship, transportation and help getting to appointments.

Reference: Tapinto.net (Nov. 11, 2020) “Caring for Elderly Parents: Can They Live Safely at Home?”

 

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Do Seniors with Dementia Show Signs of Financial ‘Symptoms’ Years before a Diagnosis?

A study at Johns Hopkins University found that beneficiaries diagnosed with dementia who had a lower educational status missed payments on bills starting as early as seven years before a clinical diagnosis, as compared to 2½ years prior to a diagnosis for beneficiaries with higher educational status.

Medical Express’s recent article entitled “Older adults with dementia exhibit financial ‘symptoms’ up to six years before diagnosis” explains that the study included researchers from the University of Michigan Medical School. They found that the missed payments and other adverse financial outcomes lead to increased risk of developing subprime credit scores starting 2½ years before a dementia diagnosis (credit scores fall in the fair and lower range).

The findings, published online in JAMA Internal Medicine, say that financial symptoms, like missing payments on routine bills could be used as early predictors of dementia and emphasizes the benefits of earlier detection.

“Currently there are no effective treatments to delay or reverse symptoms of dementia,” says lead author Lauren Hersch Nicholas, Ph.D., associate professor in the Department of Health Policy and Management at the Bloomberg School. “However, earlier screening and detection, combined with information about the risk of irreversible financial events, like foreclosure and repossession, are important to protect the financial well-being of the patient and their families.”

The study found that the elevated risk of payment delinquency with dementia accounted for 5.2% of delinquencies among those six years prior to diagnosis—reaching a maximum of 17.9% nine months after diagnosis. The rates of elevated payment delinquency and subprime credit risk persisted for up to 3½ years after beneficiaries got a dementia diagnoses, suggesting an ongoing need for assistance managing money.

Dementia is a progressive brain disorder that slowly diminishes memory and cognitive skills and restricts the ability to carry out basic daily activities, such as managing personal finances. About 14.7% of American adults over the age of 70 are diagnosed with the disease. The onset of dementia can lead to costly financial errors, irregular bill payments and increased susceptibility to financial abuse.

For their study, the researchers compared financial outcomes from 1999 to 2018 of those with and without a clinical diagnosis of dementia for up to seven years prior to a diagnosis and four years following a diagnosis. They looked at missing payments for one or more credit accounts that were at least 30 days past due, and subprime credit scores, indicative of a person’s risk of defaulting on loans based on credit history.

To determine whether the financial symptoms observed were unique to dementia, they also looked at the financial outcomes of missed payments and subprime credit scores to other health outcomes including arthritis, glaucoma, heart attacks and hip fractures. The team saw no association of increased missed payments or subprime credit scores prior to a diagnosis for arthritis, glaucoma, or a hip fracture. No long-term issues were linked to heart attacks.

“We don’t see the same pattern with other health conditions,” says Nicholas. “Dementia was the only medical condition where we saw consistent financial symptoms, especially the long period of deteriorating outcomes before clinical recognition. Our study is the first to provide large-scale quantitative evidence of the medical adage that the first place to look for dementia is in the checkbook.”

Reference: Medical Express (Nov. 30, 2020) “Older adults with dementia exhibit financial ‘symptoms’ up to six years before diagnosis”

 

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Elder Financial Abuse on the Rise during Pandemic

Elder Financial Abuse – The same isolation that is keeping seniors safe during the pandemic is also making them easier targets for scammers, reports WKYC in a news report “Northeast Ohio family warns of elder financial exploitation during the pandemic.” While this report concerns a family in Ohio, seniors and families across the country are facing the same challenges.

Two brothers enjoyed spending their time together throughout their lives. However, for the last three years, one of them, Michael Pekar, has been trying to undo a neighbor’s theft of his brother Ronnie’s estate. A few months before Ronnie died from cancer, a neighbor got involved with his finances, gained Power of Attorney and began stealing Ronnie’s life savings.

The money, more than a million dollars, had been saved for the sons by their mother. Pekar went to see an attorney, who helped uncover a sum of about $1.6 million that had been transferred from Ronnie into other accounts. A civil complaint was filed against the woman and $700,000 was eventually recovered, but nearly $1 million will never be recovered.

How can you prevent Elder Financial Abuse from happening to your loved ones, especially those who are isolated during the COVID-19 pandemic?

An elderly person who is isolated is vulnerable. Long stretches of time without family contact make them eager for human connection. If someone new suddenly inserts themselves into your loved one’s life, consider it a red flag. Are new people taking over tasks of bill paying, or driving them to a bank, lawyer, or financial professional’s office? It might start out as a genuine offer of help but may not end that way.

The possible financial abuser does not have to be a stranger. In most cases, family members, like nieces, nephews or other relatives, prey on the isolated elderly person. The red flag is a sudden interest that was never there before.

Changes to legal or financial documents are a warning sign, especially if those documents have gone missing. Unexpected trips to attorneys you don’t know or switching financial advisors without discussing changes with children are another sign that something is happening. So are changes to email addresses and phone numbers. If your elderly aunt who calls every Thursday at 3 pm stops calling, or you can’t reach her, someone may be controlling her communications.

According to the CDC, about one in ten adults over age 60 are abused, neglected, or financially exploited.

Be sure to check in more frequently on elderly family members during the pandemic because increased isolation can lead them to rely on others, making them vulnerable to abuse.

Reference: WKYC (Nov. 19, 2020) “Northeast Ohio family warns of elder financial exploitation during the pandemic.”

 

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What’s the Difference Between Nursing Homes and Assisted Living?

US News & World Report’s recent article entitled “Nursing Homes vs. Assisted Living” explains that a big question is determining what type of facility is the best fit. According to the National Institute on Aging (NIA), long-term care residences include:

  • Assisted Living Facilities
  • Nursing Homes
  • Board and Care Homes; and
  • Continuing Care Retirement Communities.

We will look at the major differences among these options.

Assisted Living. Assisted living and nursing home facilities are different in many ways. One big difference is in how to pay for them. Some assisted living facilities do not accept Medicaid and are private pay only. Medicaid does cover nursing home care because states must do so under federal law. That’s the only way some can cover the cost in many instances.

Otherwise, the primary difference is in the level of care each can provide. Assisted living is for those who need some help with daily care, but not as much as what a nursing home has to offer. These facilities are for those who can still take care of themselves, but could use a bit of help with daily activities such as:

  • Housecleaning and laundry
  • Household chores and cooking
  • Bathing
  • Medication management; and/or
  • Transportation to medical appointments or stores.

The residents use any or all of the services offered and pay for the level of care they are receive. However, the more care, the higher the cost. Assisted living residents typically have their own private apartments and share common areas, like the dining room and community rooms. Most offer three meals a day for those who don’t want to cook, 24-hour supervision and security and socializing and recreational events with other residents. Many assisted living communities even permit pets.

Nursing Homes. Nursing homes are also called “skilled nursing facilities” and provide a higher level of daily care—especially medical care that assisted living facilities aren’t equipped to handle. Along with the same help for daily living that assisted living communities provide, a nursing home can offer:

  • Nursing care
  • Rehabilitation services, such as physical, occupational and speech therapy
  • Help getting dressed or in and out of bed
  • Frequent or daily medical management for chronic conditions; and
  • Some facilities specialize in memory care for patients suffering from Alzheimer’s disease or other forms of dementia.

Board and Care Homes. Also called “residential care facilities” or “group homes,” these are small homes of 20 or fewer residents living in private or shared rooms. Similar to assisted living facilities, these places can provide personal care and meals but no nursing or medical care.

Continuing Care Retirement Communities. Also called “life care communities,” they offer different levels of service in one location, like independent housing, assisted living, and a skilled nursing facility all in one place. Residents can begin at one level of care and transition into higher care, as needed.

How to pay for care is another common misunderstanding, because unless you have long-term care insurance, assisted living is paid out of pocket. For a skilled nursing facility, if you are hospitalized and discharged to a care facility, Medicare will pay a set amount for a certain time. The responsibility for payment then goes back to the resident.

Only when a senior is legally destitute, can you use Medicaid. Talk to an elder law attorney about the details.

Reference: US News & World Report (November 52, 2020) “Nursing Homes vs. Assisted Living”

Suggested Key Terms: Elder Law Attorney, Medicare, Medicaid, Paying for a Nursing Home, Long-Term Care Planning, Long-Term Care Insurance, Medicaid Nursing Home Planning, Assisted Living, Nursing Home Care, Board and Care Homes, Continuing Care Retirement Communities, Elder Care, Caregiving, Alzheimer’s, Dementia

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Caregiving – What Should I Remember when My Parents Move in with Me?

Caregiving – Among adults living in someone else’s household, 14% were the parent of the head of household in 2017. That number is an increase from 7% in 1995, according to the Pew Research Center.

“While the rise in shared living during and immediately after the recession was attributed in large part to a growing number of millennials moving back in with their parents, the longer-term increase has been partially driven by a different phenomenon: parents moving in with their adult children,” according to the Pew report.

US News and World Report’s recent article entitled “When Your Elderly Parents Move In With You” says that if your children also return home after college, you might wind up supporting your children and your parents at the same time.

The critical thing to do is to make a plan. Discuss your goals, the finances and the possibilities, which includes caregiving by in-home care or nursing home care. Let’s look at how to care for aging parents in your home.

Get Financially Prepared. When Mom and/or Dad moves in, it will add new costs to your budget. In addition to health care for aging parents, the most disruptive implications are often the financial cost of supporting another dependent and having the space to accommodate them in the household. Talk about whether your parent will be contributing Social Security income or other retirement assets toward household expenses.

Think About Hiring Extra Help. Caring for a parent with significant health problems who needs help with basic living tasks can quickly become overwhelming for an adult child with children and work responsibilities. An aging parent might need around-the-clock care. A home health aide could be brought in during work hours or there’s also adult day health care services. However, these costs can add up. It’s not uncommon for the child who is caring for a parent to scale back his or her own career to accomplish both tasks.

Plan Before They Move In. Begin the discussion about the transition as early as you can. It can be doubly stressful to be executing a move in the middle of a crisis or urgent situation, like a health emergency or the death of a parent.

Remember that your parent in the house means you may need to schedule their activities and medical appointments. This can take time away from normal family routines.

Reference: US News and World Report (Aug. 30, 2020) “When Your Elderly Parents Move In With You”

 

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Could a Polar Bear Plunge Help with Dementia?

A “cold-shock” protein has been discovered in the blood of regular polar bear plunge swimmers at London’s Parliament Hill Lido. The protein has been shown to retard the onset of dementia and even repair some of the damage it causes in mice, according to a report in the BBC’s recent article entitled “Could cold water hold a clue to a dementia cure?”

Professor Giovanna Mallucci, who runs the United Kingdom Dementia Research Institute’s Centre at the University of Cambridge, says the discovery could help scientists with new drug treatments that may help hold dementia at bay. The research, while encouraging, is at an early stage and focuses on the hibernation ability that all mammals retain, which is prompted by exposure to cold.

The link with dementia lies in the destruction and creation of synapses, which are the connections between cells in the brain. In the early stages of Alzheimer’s and other neuro-degenerative diseases, these brain connections are lost. Mallucci saw that brain connections are lost when hibernating animals, like bears, bed down for their winter sleep, but that roughly 20-30% of their synapses are culled as their bodies preserve precious resources for winter. When they awake in the spring, those connections are reformed.

The shock of entering cold water results in a significant increase in heart rate and blood pressure, which can cause heart attacks and strokes in those with underlying illnesses. This also creates a gasp reflex and rapid breathing, which can lead to drowning, if water is inhaled.

Don’t try a polar bear plunge without consulting a doctor.

When researching this treatment in mice, scientists found that levels of a “cold-shock” protein called RBM3 soared in the ordinary mice, but not in the others. This suggested RBM3 could be the key to the formation of new connections. Mallucci proved the link in a separate experiment which showed brain cell deaths in Alzheimer’s and prion disease could be prevented by artificially boosting RBM3 levels in mice. This was a major breakthrough in dementia research, and their findings were published in the scientific journal Nature.

Professor Mallucci contends that a drug which prompted the production of RBM3 might help slow—and possibly even partially reverse—the progress of some neuro-degenerative diseases in people. RBM3 hadn’t been seen in human blood, so the obvious next step was to find out whether the protein is present in humans.

It’s hard to get people to become hypothermic by choice, but Martin Pate and his group of Londoners who swim throughout the winter at the unheated open-air London Parliament Hill Lido pool voluntarily made themselves hypothermic on a regular basis, so he thought they’d be ideal subjects of a study.

The tests showed that a significant number of the swimmers had markedly elevated levels of RBM3. All of them become hypothermic, with core temperatures as low as 93.2F. A control group of Tai Chi participants who practice beside the pool but never actually swim, showed no increase in RBM3 levels nor had they experienced very low body temperatures.

The risks associated with getting cold outweigh any potential benefits, so cold water immersion isn’t a potential dementia treatment. The key is to find a drug that stimulates the production of the protein in humans and to show that it really does help delay dementia.

Reference: BBC (Oct. 19, 2020) “Could cold water hold a clue to a dementia cure?”

Suggested Key Terms: Elder Care, Dementia, Alzheimer’s Disease, Treatments

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HIPAA and Caring for a Loved One from a Distance

Trying to coordinate care from a distance becomes a challenge for many with HIPAA, especially since as many as 80% of caregivers are working. Add COVID-19 into the mix, and the situation becomes even more difficult, reports the article “When your parent is far away and you are trying to care for them” from the Pittsburgh Post-Gazette.

The starting point is to have the person you are caring for give you legal authorization to act on their behalf with a Power of Attorney for financial affairs and a Health Care Directive that gives you authority to receive health information under HIPAA (Health Insurance Portability and Accountability Act). It is HIPAA that addresses the use, disclosure and protection of sensitive patient information.

Next, have a conversation about their finances. Find out where all of their important documents are, including insurance policies (long-term care, health, life, auto, home), Social Security and Medicare cards. You’ll want to know where their tax documents are, which will provide you with information on retirement accounts, bank accounts and investments.

Gather up family documents, including birth, death, and marriage certificates. Make sure your loved one has completed their estate planning, including a last will and testament.

Put all of this information into a binder, so you have access to it easily.

Because you are far from your loved one, you may want to set up a care plan. What kind of care do they have in place right now, and what do you anticipate they may need in the near future? There should also be a contingency plan for emergencies, which seem to occur when they are least expected.

Find a geriatric care manager or a social worker who can do a needs assessment and help coordinate services, including shopping for groceries, medication administration and help with basic activities of daily living, including bathing, toileting, getting in and out of bed, eating and dressing.

If possible, develop a list of neighbors, friends or fellow worshippers who might create a local support system. If you are not able to visit with any degree of frequency, find a way to see your loved ones on a regular basis through video calls. It is impossible to accurately assess a person’s well-being, without being able to see them. In the past, dramatic changes weren’t revealed until family members made a trip. Today, you’ll be able to see your loved one using technology.

You may need to purchase a smartphone or a tablet, but it will be worth the investment. A medical alert system will provide further peace of mind for all concerned. Regular conference calls with caregivers and your loved one will keep everyone in touch.

Caring from a distance is difficult, but a well-thought out plan and preparing for all situations will make your loved one safer.

Reference: Pittsburgh Post-Gazette (Sep. 28, 2020) “When your parent is far away and you are trying to care for them”

 

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Can Senior Care Facilities Use ‘ Granny Cams ’?

A bill in Georgia that would permit residents in assisted living communities and personal care homes to install electronic monitoring equipment (Granny Cams) in their rooms has been met with resistance. There are some members of the long-term care industry the oppose HB 849, so-called “granny cam” legislation due to privacy issues. The legislation—which also covers nursing homes—was introduced by state representative Demetrius Douglas (D-Stockbridge). Douglas contends that the technology is needed now more than ever.

Several states have similar laws.

McKnight’s Senior Living’s recent article entitled “Georgia Legislature blocks ‘granny cam’ legislation; industry reps raised concerns” reports that Tony Marshall, president and CEO of the Georgia Health Care Association, says he previously spoke with Douglas and other legislators about the granny cam bill and his concerns. He said concerns were also shared by the state ombudsman and various advocacy groups.

“Surveillance cameras observe — they do not protect — and the use of such cameras in a healthcare setting significantly increases the risk of violating HIPAA [Health Insurance Portability and Accountability Act], federal and state privacy regulations,” Marshall told McKnight’s Senior Living. “We also have concerns related to several other technical aspects of the bill.”

Marshall also noted that the Georgia Health Care Association supports “transparency and measures to ensure that the highest quality of care is being provided to elderly Georgians,” while also “valuing a home-like setting and honoring each resident’s dignity and right to privacy.”

He said his association believes that true quality improvement happens by collaborative efforts with legislators and other players to bolster the ability of nursing centers to recruit and retain a skilled, competent workforce. This also will “further programs designed to educate healthcare professionals, consumers and communities-at-large on abuse prevention and identification,” Marshall said.

The bill allows electronic monitoring equipment to be put in a resident’s rooms in assisted living communities, personal care homes, skilled nursing facilities and intermediate care homes. The resident would be required to provide written consent from any roommate and notify the facility before installing a device. A sign must also to be posted to let visitors and staff members know about the granny cam. The facility also wouldn’t be permitted to access any video or audio recording from the resident’s device.

Douglas said the pandemic has shown the need for cameras and noted that other states have adopted similar measures, according to the Atlanta Journal-Constitution. The state legislator remarked that he introduced the legislation after being contacted during the lockdown by family members, who said they weren’t told about outbreaks or immediately told when an elderly family member died.

There are six states—Minnesota, Missouri, North Dakota, Oklahoma, South Dakota, Texas, and Utah—that have laws requiring assisted living communities to accommodate resident requests to install electronic monitoring equipment in their rooms.

New Jersey also has a “Safe Care Cam” program that loans such equipment to healthcare consumers, including families of assisted living and nursing home residents.

Reference: McKnight’s Senior Living (Sep. 15, 2020) “Georgia Legislature blocks ‘granny cam’ legislation; industry reps raised concerns”

 

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What’s the Latest Trend in Long-Term Care Insurance ?

Approximately half of Americans turning age 65 today will require some type of long-term care (LTC) and therefore long-term care insurance in their lives. The older a person, the more likely he or she will need LTC at some point.

The Treasury Department also reminds us about the general aging of the national population because much of the baby boom generation already is above that age, and the rest will be within 10 years.

FedWeek’s recent article entitled “Report Sees Mismatch between Long-Term Care Insurance Needs, Purchases” also notes that private insurers began offering long-term care insurance in the 1970s in response to demand for financial protection against the risk of having to enter a nursing home. The sales of new policies hit a high in the early 2000s but have since dropped because many insurance companies left the market due to the poor financial performance of these products.

The sales of these policies peaked in 2002, when the government started its own program for federal employees, the Federal Long Term Care Insurance Program.

About 750,000 people bought policies, but the numbers have fallen steadily since. It was down to just 57,000 in 2018, despite the fact the share of the population in the age group most likely to purchase private LTCI were up from 9.5% in 2010 to 11.4% that year.

The Treasury Department report also emphasized that the government doesn’t recommend purchasing or not purchasing insurance. However, it said that currently much of the burden of providing this care falls on the Medicaid program. It paid $159 billion for these expenses in 2018, while LTC insurance covered only about $10 billion, and individuals paid another $55 billion out of pocket. It is also hard to know the amount of unpaid care provided by family members.

The report said that for the private LTC insurance market to meet the coming demand, there will have to be more innovation in the way this type of insurance is designed and delivered.

This may be having LTC coverage as a rider to other types of insurance, instead of a stand-alone product, along with policies with a more limited scope. This limited scope could be to cover only nursing home care and only for up to a year, which would mean lower premiums.

The Treasury Department also said there should be better coordination when it comes to how such insurance is regulated, education and awareness programs regarding possible need for coverage and tax incentives to buy LTC insurance.

Reference: FedWeek (Sep. 10, 2020) “Report Sees Mismatch between Long-Term Care Insurance Needs, Purchases”

 

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