The Long-Term Care Maze: Getting Care While Getting Older

Preparing for the possible costs of future impairment and long-term care is a task that everyone will face as they age. Losses in the ability to function is a natural part of the aging process, and those losses become more severe as people get older. More than half of Americans over age 85 have physical or mental impairments and require personal assistance with daily routines such as eating, bathing, and dressing, often in long-term care facilities.

Older Americans who need long-term services and supports usually need it for a long time—in some cases, until they die. When a person’s needs for long-term services and supports can no longer be met either inside the home or without the intervention of paid providers, the elder enters “the long-term care system.” Think of it as “the long-term care maze.” The elder and his or her family are now embarking on an arduous journey through murky waters. 

It’s important to note that the current system in our country for meeting the long-term care needs for older adults is not a system at all. It’s a hodgepodge of services that fails to meet the needs of the elderly and disabled. It is economically inefficient and the quality of services is often questionable. Our non-system does not fund most long-term services and supports. In fact, the system for financing long-term services and supports is biased in favor of providing extended care in an institutional setting, which usually means a nursing home. Most people, given a choice, would prefer to age in comfortable surroundings--at home.

How do families fund their loved one’s journey through the long-term care maze, especially if they want to grow old at home? One alternative is to “self-insure” by setting aside personal savings and assets and then supplementing those personal resources with the donated, or free, care of family and friends. Many seniors rely on donated care and their own savings to finance care.

Another option is to rely on public benefits. Medicaid is the dominant public insurance program for long-term services and supports. Its eligibility rules permit middle-income people—even older persons whose income in retirement leaves them fairly comfortable—to qualify for coverage by exhausting, or “spending down,” their income and assets. Unfortunately, Medicaid provides home health care in only limited circumstances. Medicare does not cover long-term services and supports but has become a de facto financier of extended acute care services, its home health care benefit, and, increasingly, its hospice benefit. Benefits provided by the U.S. Department of Veterans Affairs can help but they’re available to only a small fraction of the population. For people who need chronic care at home, almost no funding is available to help them in the day-to-day self-management of their illness.

The long-term care system can be frustrating—but it doesn’t have to be. If you start planning for care before you actually need it, the long-term maze will be far less difficult to navigate. If you want to get started, Takacs McGinnis can help. Just give us a call at 615.824.2571.

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