Estate Law Blog

Long-Term Care Commission Issues "Call to Action"

On September 20, 2013 the federal Commission on Long-Tem Care issued a “Call to Action” in its report to Congress.  Noting that over 12 million Americans currently rely on some form of Long Term Services and Supports (which it abbreviates to LTSS), it projects that this number will more than double to 27 million by the year 2050, as the “baby boom” ages.

Medicare covers very little of long-term facility expenses, contrary to popular belief.   It will only cover 20 days fully (IF you have had a 3-day hospitalization, require skilled care and meet certain other criteria); you pay your own expenses up to $140 per day for days 21-100, and Medicare pays the balance; and coverage ends after 100 days.  In 2011, 21.6% of long-term care expenses were paid out-of-pocket; 11.6% were other private sources (long term care insurance, primarily); Medicaid paid 62.3% of such expenses; and “other public” sources made up the remainder.

The so-called “sandwich generation” of workers with aging parents (and in many caeses, also children they are supporting wholly or in part) are caught in the middle.  Most families need to combine family caregiving with other programs while addressing the fact that eventually, assisted living or nursing home care may be necessary.

Although many long term care facilities do have Medicaid patients, there are often a limited number of beds resulting in waiting periods.  Others will accept clients that they know will become Medicaid patients, provided that an initial period is paid out-of-pocket (referred to as “key money.”)

Medicare will pay for various home care services for a limited period of time, but a doctor must certify them as “medically necessary” every 60 days.  A helpful handbook about Medicare coverage is available from the Department of Health and Human Services.

Elder and disability planning includes – but is certainly not limited to – helping families understand what would be involved for a family member to qualify for Medicaid or other available programs.  Some families may have certain types of assets that can be transferred or put into a properly drafted trust without a penalty (although Medicaid may have a lien against the beneficiary’s estate).  Social Security and long-term care insurance are also potentially important and the process for each is more difficult than one might expect.  We will make note of some of the many sub-topics in this blog.

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