By Laurie Bailey
With all the recent talk about health care reform, aging baby boomers and their families should be aware that there is little in the legislation that will help pay for the current generation’s long-term elder care costs.
“Medicare does not cover long-term care services in a nursing home or in one’s own home and this will not change any time soon,” says June Ninnemann, LCSW, executive director of Norwood Seniors Network.
The average daily cost for a semi-private room in a nursing home or assisted living facility is about $200 or about $6,000 a month – a cost that can be daunting to seniors on a fixed income who may also be taking care of their own very-aged parents.
Since its beginning, Medicaid- waiver programs that are funded by the state have been geared toward in-home care for the elderly rather than nursing home care. But the state of Illinois is running a huge deficit, causing low or slow payment for provider agencies for this type of care. Several Illinois providers have had to close their doors.
Coverage for home health services is also being reduced.
“Unfortunately, this is happening at a time when people are being discharged from the hospital more quickly and Medicare is not filling in the gap with home health care benefits,” says Ninnemann.
Additionally, Medicare has not increased the reimbursement rates for primary care physicians, specifically board-certified geriatricians. This is a situation that is contributing to the decreasing number of these specialists. There is currently little financial incentive for doctors to be board-certified in geriatric medicine which includes several thousands of dollars in exam and other certification requirements every three years.
“Private pay will continue to be the leading payer for in home care. It will also be the source for nursing home residents, until they spend down to becoming Medicaid eligible,” says Ninnemann.
She suggests that while they are younger and healthier, people need to plan for the expectation that care will be needed at some level whether it’s in the home or at a long term care facility.
One thing they can do, she adds, is to evaluate the benefits of purchasing long-term care insurance for themselves or family members.
“It’s really the single biggest thing to do to help secure that they have the resources when they are needed,” she says.
Most people in their 50s can purchase this insurance at lower premiums, but these policies are virtually impossible to purchase over the age of 65.
She says it’s also worth looking at long-term care insurance benefits that may be available through your employer. Many of these policies offer worthwhile benefits, for example, suspension of premium payments if you become disabled and flexible benefits that pay for care at home or in a facility.
The Veterans Aid and Attendance pension can be an excellent source of funds for middle-class veterans and their spouses, and it will likely continue to be funded by the VA at currents levels. Applicants should be aware they need all the relevant paperwork in hand, including separation papers (form DD-214), marriage and death certificates, a medical evaluation form from a physician and other documentation that lists your current medical issues, net worth limitations, net income and out-of-pocket medical expenses.
This documentation should be kept in a safe place to make the applications process expedient. The main reason benefits are denied is because of missing pertinent information, says Ninnemann.
According to the Family Caregiver Alliance, 65% of seniors in the United States receive care exclusively from family members. According to the same source, one-fourth of all American households are actively involved in providing care to older family members.
Every family has different goals and values in terms of caring for its aging loved ones, explains Ninnemann. “We highly recommend that all families get a consultation from one of our family care managers. They are a source of professional guidance, up-to-date benefit information and solid assessment skills. A care manager can help a family craft a personalized plan of care before a crisis arises.”
Norwood Seniors Network provides in-home care and professional care management services to home-bound seniors throughout the Northwest side of Chicago and surrounding suburbs. For more information regarding family consultations, in-home care giving services, volunteering and career opportunities with Norwood Seniors Network, visit www.norwoodseniorsnetwork.org or call 773-631-5673. For more information about the Veterans Aid and Attendance pension, go to VeteranAid.org.