Long Term Healthcare

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Photo: Sri Maiava Rusden

Keep a hard copy. “Document your long-term-care plan,” says Byers, adding that it is important to designate a family member or friend as your long-term-care advocate and educate them on your policy coverage.

“Take into account family dynamics,” adds Mishan. “If you know that one of your kids is flaky, don’t put them in charge.”

Plan accordingly. It’s important to note that long-term-care insurance shouldn’t be considered a substitute for aging well. Braun, who is skeptical of long-term-care insurance, insists that, even among customers who can afford coverage, companies cherry pick those who have no, or very low, medical risks. She’d prefer a style more like auto insurance. “The most effective way for the U.S. is to insure everyone, risky and unrisky,” she says. “You insure both risky and un-risky drivers, but it works.” She adds that long-term-care insurance should be mandatory, just like car insurance is.

Tip: Fill out your insurance forms honestly and completely.  If you conceal a pre-existing medical condition, you risk losing your coverage.

When It Begins

Most plans start providing coverage once you are unable to perform two to three activities of daily living (ADLs). ADLs consist of everyday tasks and activities you regularly do on your own, such as bathing, toileting, dressing, eating or transferring (moving in and out of bed). Policies can also kick-start if you become cognitively impaired. Needing regular assistance with two or more of these activities—or “benefit triggers,” as the insurance company calls them­—will kick-start the policy for which you’ve been preparing. 

However, insurers don’t pay claims the minute you start needing help. Long-term-care policies have an elimination period, in which you have to pay for your long-term-care needs before your benefits begin. This period can last as long as 100 days, and can be either in calendar days or service-only days.

For example, if your policy has a 20-day elimination period, you pay for your care for the first 20 days, either 20 consecutive calendar days, or 20 days that you needed care. So, if you only needed assistance three days a week, it can be a long time before your policy covers your needs. The shorter the elimination period you choose for your policy, the more expensive your premiums will be.

It’s also important to find out if your insurer will waive policy premiums while you’re receiving care. Some policies automatically include it, others offer it as an option.

In addition, remember your policy will only cover what you originally designated as your future care benefits. Your claims will be paid either by the day, week or month, as decided upon when you purchased your policy. But, if you don’t use all of your coverage, and you have compounded interest on your policy, your benefits carry over, even if you select limited coverage years.

“If you don’t make claims that benefit will still compound,” says Mary Murphy Mattos, a certified long-term-care consultant with Kersten and Associates. “This is especially important if you’re in the younger age bracket because your benefits last longer. When you’re older you have to [decide] whether you want compounded benefits or more benefits right away.”

Government Assistance

Everyone’s heard of Medicare and Medicaid as government-funded safety nets, but these programs are only available as a last resort and don’t always provide the care you need, or want. 

“I would strongly recommend that people not depend on government for long-term-care,” states Stanton. “You need to take a look at a plan where you can provide for yourself.”

Medicare is only available to qualifying U.S. citizens who are 65 or older. It covers hospital bills, medical insurance and some prescription drugs. However, it does not cover nursing home and other long-term-care needs, and is applicable only after medical costs have extinguished most or all of your personal financial assets.

Medicaid, on the other hand, does cover long-term-care costs, but also has a rigorous qualification process. It’s a program funded jointly by the federal and state governments, but it, too, is only for low-income elders who have already used up their savings on long-term-care. Cunningham also stresses not relying on Medicaid. “It is not a given. It’s here today but we don’t know what will happen with the program or how it will change,” she says. “So you can’t say, ‘Well, in 20 years I’ll just have the state of Hawai‘i pay for my care.’”

Photo: Sri Maiava Rusden

Your Health Is Your Wealth

Financial planning, important as it might be, is not the only aspect of long-term-care preparation. It’s just as important to keep yourself healthy.  

“If you’re going to live to be 100 years old, that’s great,” says Braun. “But if you’re going to be sick the last 30 of those 100 years, that’s not great.”

She recommends that people build and maintain a strong network of family and friends for well-being and support, as well as find activities that are fun and meaningful. Staying healthy isn’t only about doctor appointments and medications. Byers adds that planning for your long-term healthcare includes being active—even in small ways—as well as eating healthfully and living tobacco free.

As you age, make your home safer to prevent unnecessary falls. Install grab bars in showers and tubs, and remove rugs that might trip you. 

“Being healthy may help lower the number of medications you take, which subsequently helps save a lot of money. Your health is your wealth,” says Noemi Pendleton, the director of the Executive Office on Aging, a state funded office enacted by the Legislature.

Cunningham suggests keeping track of up-coming exams, including scheduling dates and also maintaining a good relationship with your doctor. “We’re all aging, we don’t get away from that,” she says. “You need to have the mindset of wanting to stay as healthy as possible.”

Plan for Yourself, Plan for Your Family

Mishan knows that planning—both finan-cially and physically—is the first step on the path to solid long-term-care. “As a caregiver you get to see what you’re going to possibly go through later. In my particular case I don’t fear death as much,” she says. “But I do want to go to a lawyer to make sure that the people I know, know what I want. It’s made me think a lot about getting that all in order.”

Although she is struggling from the emo-tional and financial aftermath of being a former around-the-clock caregiver, Mishan knows that standing idle is the worst thing to do when it comes to preparing for long-term-care.

For many people, long-term healthcare will be an inevitable part of aging. But it doesn’t have to be all doom and gloom; aging can be an exhilarating experience. A well-laid and executed plan can make aging gratifying.