Why we make wrong long-term care decisions

Long-term care can be confusing and frightening. It can help to know why and when some commonly held ideas are wrong and when to go for more information. Here are some misconceptions that need correction and redirection.

• I can stay home no matter how sick I am and people will come in. It will be less expensive

The idea that at-home care is less expensive than nursing care depends on the level of care. Staying at home can work if the need for care is less extreme. Twenty-four-hour, seven-daya-week care at home will likely cost more than a nursing home. Whether it is worth it could depend on your available income and assets including long term care insurance or other backup funds. Live in care can have other problems including tax issues or dependability.

• I’ll never get sick but if I do, my family can take care of me

People do stay at home for long periods even after they are ill. Parents share homes with adult children. Spouses may have husbands or wives physically and mentally able to care for them. Hospice care which is covered by Medicare insurance can help. But longer term chronic conditions can exhaust families and the level of care needed may be beyond the abilities of adult children or spouses who might also be sick or need to work or live at a distance. There is limited government help at home in Pennsylvania and it is mostly for those with very limited resources. It cannot always be assumed that family can take care of a seriously ill person indefinitely.

• I only need to know about Medicaid if I am broke and I am not broke now

When you are broke it often is too late to plan effectively. Planning needs to come in advance. This is even if you never expect to use any sophisticated techniques. You need to know the smart way to spend money in advance even if you never go on Medicaid and smart spending is not always obvious.

• Nursing homes that take Medicaid are inferior or government run

Some of the best facilities in the area are Medicaid certified. Pocopson Home, the Chester County facility, has an excellent reputation. Each facility has to be considered on its own. There is nothing about a Medicaid certified facility in itself that makes it less qualified to care for residents. Some of the considerations are source of payment where non-profits or church related may have an advantage with fund raising. Also, for the county facility, taxpayer dollars help to provide a stable, well trained and consistent workforce. For profit facilities may

have greater difficulty but these are all generalizations and conditions also change. It is a good idea to review in advance and see what makes sense for you if needed at a later date.

• I can stay in assisted living/personal care indefinitely no matter what my condition

Personal care facilities are limited by law. There are levels of care.

• I have long term care insurance. That takes care of everything

When I ask people who have long term care insurance the length of their elimination period, their daily benefit, the maximum payout and whether the elimination period depends on calendar days or days of service, they generally do not know. In some

cases you can have long term care insurance and still qualify for Medicaid. It depends.

• I should transfer everything I have to my children and wait five years because of the “lookback” rules

Usually a big mistake. Since the Deficit Reduction Act went into effect on February 8, 2006 establishing a five year “lookback,” there has been even more misunderstanding about gifting than there

had been before. The gifting rules are complicated. Planning can be done in some cases even during the lookback period and even when a person is in a nursing home but not after the funds have been spent. Special rules about Medicaid can, in particular, protect spouses even after you are sick and disabled children but they cannot help after the money is spent. When your health begins to affect your assets you

should speak to a qualified elder law attorney.