Planning for long term care
By Patricia M. Dunn

Chronic conditions such as AIDS, disability and age-related problems are changing the structure of the health care delivery systems in the United States. Supervision or actual care is often needed when chronic illness strikes. Family members are less able than in prior generations to provide care needed. Thus, we turn to day care, home care, assisted living and nursing homes to fill the gap.

Later in life, especially in the 80's and 90's people begin to need help with shopping, cleaning, cooking, walking and/or bathing. If dementia strikes, 24-hour care in a facility may become necessary. Costs may be overwhelming.

Assisted living, in 1999 averaged about $35,000 per year. Home care costs vary with need. Personal care averages about $8,000 per year while skilled nursing care can be $25,000 or more. Nursing home care averages about $200 per day or $70,000 per year.

The trend of costs is upward.
Medicare payments are limited and have specific criteria for eligibility. Medicaid requires a spend-down to a minimal savings account. So, the possibility of privately paying for care is real. Some life insurance policies allow living benefits to pay for terminal care. Long-term care insurance can cover much of our long-term care, but buying it is confusing and rates vary. It's an option for people who can afford it and for those who want to protect their assets. The cost of long-term care insurance depends on the age at the time of purchase, the state of health and the benefits you choose. Consider buying it while you or your parents are in the 50's or by age 65, since premiums escalate greatly after that.

Examining long-term care policies can be mind boggling and confusing as we look at deductibles, daily benefits, coverage, compounding and actual qualifications for eligibility. Add to this the lack of objectivity when a salesman knows much more about it than you do. 

To assist our fellow nurses, patients and families to purchase wisely, our newly formed group of semi or fully retired nurses decided to take on a year-long project of making sense out of long-term care insurance. Together, we examined reams of literature, articles, government publications and listened to salesmen's lectures. We will share our findings through the next several monthly columns in Mass. Nurse. In the meantime, you may wish to access information from the sites listed here. Look for additional resources in future editions of Mass. Nurse.