Hello HBers, last week I attended a course for a professional designation and one of the topics, Long Term Care, really resonated with me. My parents are already in their 60s and I often think what will happen to them if they can no longer care for themselves. I think about what role will I play in making sure they are safe and cared for- providing care or funding care. Here's what I learned from the course and thought I'd share it in case any of you may find it helpful as well.

Long Term Care is LTC is custodial care for chronic conditions. It can be either skilled or non-skilled care, and can be delivered in the home of in facilities such as nursing homes or assisted living environments.

Who pays or provides LTC?
Family The financial burden could bankrupt them or adversely affects children’s own retirement funding. The emotional burden could strain any family relationship.
Self-insure Ask yourself, “how much will be needed and how much in disposable assets does one have?”
Veterans Administration VA Veterans of foreign wars may be eligible for nursing home benefits by applying for acceptance into subsidized VA programs.
Medicare does not have long term coverage. Here’s what Medicare Part A provides only after several requirements are met:
• A consecutive three day hospital stay must precede entry into a skilled nursing home facility and for the same medical condition
• The care needed by the patient must be skilled nursing
• The patient’s condition must be improving
There is a sliding scale of coverage payments from Medicare that will likely result in significant monetary outlay on behalf of the patient.
• First 20 days in a Skilled Nursing facility- Medicare pays in full
• Days 21-100- Patient pays $148 per day as a co-payment
• Days 101 plus- Medicare pays nothing
Medicaid pays for LTC services for those at or below poverty level. Anyone who still has assets, but applies for Medicaid will be required to divest many of those assets to that states’ Medicaid program. Asset qualification review looks back five years.
LTC insurance policy

Reasons for purchasing a Long Term Care policy
• Preserve independence
• Guarantee choice of care and caregivers
• Protect assests and standard of living
• Avoid being a burden on family
• Leave more assets to family, church, school or worthy cause
• Peace of mind

Benefits provided by a Long Term Care policy
In home coverage
Home health care- medically necessary skilled care performed by trained medical personnel
Home care- more custodial in nature
Assisted Living Facility
Nursing Home
Skilled care- requires trained medical personnel authorized by a physician
Intermediate care- similar to skilled care, but on a less frequent basis
Adult Day Care
Hospice Care benefits paid for symptom control for terminally ill patients

What determines the approval of a claim for LTC insurance? (Triggers)
Inability to perform any 2 of the Activities of Daily Life:
1. Eating: Feeding yourself by getting food into your body from a receptacle such as a plate, cup or table or by a feeding tube or intravenously;
2. Dressing: Putting on and taking off all items of clothing and necessary braces, fasteners, or artificial limbs;
3. Bathing: Washing yourself by sponge bath; or in either a tub or a shower, including the task of getting in or out of the tub or shower;
4. Toileting: Getting to and from the toilet, getting on and off the toilet, and performing associated with personal hygiene;
5. Transferring: Moving into or out of bed, chair, or wheelchair; and
6. Continence: The ability to maintain control of bowel or bladder function; or, when unable to maintain control of bowel or bladder function, the ability to perform associated personal hygiene, including caring for a catheter or colostomy bag.
-OR-
Cognitive Impairment
Severe congnitive impairment means a loss or deterioration in illectual capacity that is: (1) comparable to Alzheimer’s disease or similar forms of dementia and (2) measured by clinical evidence and standardized tests that reliably measure impairment in the individual’s short term or long term memory, orientation as to people, places or time, and deductive or abstract reasoning.

Building and rating the LTC policy
Daily or monthly benefit based on current age, sex, state of residence and medical history (at issue age 18-84). How much will you need based on your area’s expenses? (Genworth survey attached)
Waiting (or Elimination) period. How many days can you self-insure and pay for the care out of pocket? (30, 90, 180, 365 days).
Benefit period. How many years do you want LTC benefits before you self-insure and pay out of pocket again? (3, 5, 10 years or lifetime)
Inflation option. (CPI Consumer Price Index, Simple, or Compound)
There are lots of riders to add to the policy to fit needs and any concerns.

To learn more about the costs of Long Term Care (ie home nurses and nursing facilities rates) https://www.genworth.com/ was recommended by the course instructor. Every year the company surveys care rates for each state.

My brother and I will soon have the uncomfortable conversation about LTC with our parents. Have you discussed LTC with your partner regarding each other's parents or for yourself?