Long-Term-Care Planning; Elder Law

Elder Law is our area of legal practice that addresses the issues of families and people regarding aging. Sometimes it is called Long Term Care Planning. People are usually thinking about “Nursing Home” care when they think of this issue. However, there is really much more to it than that. As people age and have medical problems, they may need help with their everyday affairs and activities. The need for this care, over an extended period of time (rather than a short stay at a hospital) is what we call Long Term Care. The necessary care can be provided at home, at some sort of residential community such as an independent or assisted living community, or in a medical facility such as a Nursing Home.

You need to think about the care that may be needed, where it will be provided, and the cost of that care. Most medical care is covered by health insurance of some kind. But, the Long-Term-Care we are talking about is not medical care, so is not covered by health insurance. A short stay in a skilled nursing facility may be covered by health insurance, but Long-Term-Care will not be.

Elderly man on a wheelchair with a nurse pushing

When engaging in Long-Term-Care Planning, the primary goal is to see that the individual in question is properly cared for as needed. Secondary goals are to see that the individual can pay for the needed care without harming the family finances, or to see that the individual will qualify for government benefits in order to pay for that care.

The only government program that pays for long-term custodial care, is Medicaid. Medicaid is a welfare program only available to those with low assets and income. Often this means we engage in planning with the goal of properly qualifying the individual for Medicaid benefits while also preserving assets for the individual and the family. This is usually a difficult balancing act.

Care And Living Arrangements

You must consider the current and future possible living arrangements of the elder in question. There are many care and living options available. The first option is to stay in the private home, and have outside helpers provide whatever care or assistance is needed. This is a pleasant choice, since it will mean that the elder can stay where everything is familiar. However, a common problem with many private homes, especially older ones, is that they have significant hazards and barriers to safe living. They often have stairs and narrow hallways and doorways. They usually lack safety devices such as hand rails and adequate lighting. If you want your loved-one to stay at home, then you should ensure that the home is made as safe as possible.

If your aging family member does not need nursing home level care, then it is appropriate to consider other care options, and their costs. The basic options such as retirement communities, and assisted living facilities, generally only have one payment method – private-pay out of one’s own funds. So, the issue of Medicaid eligibility only comes into play when you are considering nursing home care, and the rules and regulations governing don’t apply until then (all though you may need to consider them now anyway).

These types of communities vary in style, quality and cost. There are some facilities called “Life Care” or “Continuing Care” communities. These usually have some sort of “buy-in” fee of many thousands of dollars (perhaps $100,000 to $300,000) and then a monthly fee of varying amounts. These facilities have in-house long-term-care facilities and can provide a continuum of care in the same place, usually at much less cost than a private nursing home (because of the buy-in fee). Many of these types of communities are quite luxurious and have many amenities that are quite desirable. However, these facilities are designed for people who have significant assets and income and they pre-qualify people financially. This is a good option if you have the funds to afford it.