Long-term care myths and answers
Having worked with families for many years who are confronting long term care, I have to admit I see some changes. The most significant have to do with some of the myths surrounding care. What has not changed is denial.
Here are some of today’s major myths.
• I’ll never get sick but if I do, my family can take care of me. This explanation is not new but has taken on added significance now that there is a widespread belief that everyone can be cared for at home. In some cases, people do stay at home for long periods even after they are ill.
• Parents share homes with adult children who assist them. Spouses may be fortunate to have husbands or wives physically and mentally able to care for them. Others go directly from healthy to hospice care which is covered by Medicare insurance. Still there are limitations. The healthy spouse can become ill or pass away first. The level of care needed may be beyond the abilities of adult children. It cannot always be assumed that family can take care of a seriously ill person indefinitely.
• 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 needed. It can work when there is not extreme need. Twenty-four hour, seven-day-a-week care at
home will likely cost more than a nursing home.
• I only need to know about Medicaid if I am broke and I am not broke now. The idea that “I will only think about Medicaid if I am broke” is a mistake. When you are broke it often is too late to plan effectively. This is true even if you never expect any sophisticated planning. If you gave money to your son or daughter during the past five years when they were out of work, you could be penalized later. If you do not plan for your burial expenses in advance with an irrevocable burial reserve, your family could be paying for a funeral with their own funds unnecessarily. You need to know what bills you should pay and when.
• Nursing homes that take Medicaid are inferior or government run. Some of the best facilities in the area are Medicaid certified. Pocopson Home, the county facility, has an excellent reputation. Each facility has to be considered on its own but 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.
• I can stay in assisted living/ personal care indefinitely no matter what my condition. Personal care facilities are limited by law. One of the major considerations has been the requirement that residents be able to evacuate in the event of fire. 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. We have had clients on Medicaid who also are receiving long term care insurance. It can depend on how much and the terms of the policy.
• If I find myself getting sick, I should transfer everything I have to my children and wait five years because of the “lookback” rules. 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. For the vast majority of potential patients, the “transfer everything to the children” idea is a terrible idea. Also planning can be done in some cases even during the lookback period. I ask clients do they really want to ask their children for money. There are special rules about Medicaid that can, in particular, protect spouses and disabled children. The rules are complicated and you should seek professional advice if needed.