Receiving and Paying for Long Term Care – The Importance of Being Prepared for Disability (part 3 of 6)

Long Term Care

Nursing Home Stays

According to the National Nursing Home Survey 2004 Study, the most recent of its kind, the national average length of stay for nursing home residents is 835 days, with over 56% of nursing home residents staying at least one year. Significantly, only 19% are discharged in less than three months. Those residents who were married or living with a partner at the time of admission had a significantly shorter average stay than those who were widowed, divorced or never married. Likewise, those who lived with a family member prior to admission also had a shorter average stay than those who lived alone prior to admission.

While a relatively small number (1.56 million) and percentage (4.5%) of the 65+ population lived in nursing homes in 2000, the percentage increased dramatically with age, ranging from 1.1% for persons 65-74 years to 4.7% for persons 75-84 years and 18.2% for persons 85+. According to the U.S. Census Bureau, 68% of nursing home residents were women, and only 16% of all residents were under the age of 65. The median age of residents was 83 years.

Long Term Care Costs Can Be Staggering
Not only will many individuals and families face prolonged long term care, in-home care and nursing home costs continue to rise. According to the Genworth 2016 Cost of Care Survey, Assisted Living, Adult Day Services, and Home Care Costs Texas averages for long term care costs are as follows:

  • Monthly base rate (room and board, two meals per day, housekeeping and personal care assistance) for assisted living care is $3,515 (or $42,180 annually).
  • Monthly rate for a private room in a nursing home is $5,931 (or $71,172 annually).
  • Daily rate for a semi-private room in a nursing home is $4502 (or $54,024 annually).

In the next post in this series, I will take a look at some of the options for paying for long-term care.

The Alzheimer’s Factor – The Importance of Being Prepared (part 2 of 6)

The Alzheimer’s Factor

Alzheimer’s is growing at an alarming rate. Alzheimer’s increased by 46.1% as a cause of death between 2000 and 2006, while causes of death from prostate cancer, breast cancer, heart disease and HIV all declined during that same time period.

Facts and Figures about Alzheimer’s Disease

The 2017 Alzheimer’s Association annual report titled, “Alzheimer’s Disease Facts and Figures” explores different types of dementia, causes and risk factors, and the cost involved in providing health care, among other areas. This report contains some eye-opening statistics:
• An estimated 5.5 million Americans of all ages have Alzheimer’s disease. This figure includes 5.3 million people aged 65 and older and 200,000 individuals under age 65 who have younger-onset Alzheimer’s (3.3 million are women and 2.0 million are men).
• One in ten people age 65 and older (11 percent) has Alzheimer’s disease.
• About one-third of people age 85 and older (32 percent) have Alzheimer’s disease.
• Eighty-two percent of people who have Alzheimer’s disease are age 75 or older. The number of people aged 65 and older with Alzheimer’s disease is estimated to reach 7.1 million in 2025 – more than a 35% increase from the 5.1 million aged 65 and older currently affected.
• Every 66 seconds, someone in the United States develops Alzheimer’s. Thus, approximately 480,000 people age 65 or older will develop Alzheimer’s disease in the United States in 2015.
• By 2050, it is projected that there will be 13.8 million individuals aged 65 and older with Alzheimer’s – unless medical breakthroughs identify ways to prevent or more effectively treat the disease.

Caregivers are at risk of developing health problems.

There are currently approximately 15 million unpaid caregivers (family members and friends) providing care to persons with Alzheimer’s or dementia in 2017. According to the Alzheimer’s Association, those persons are at high risk of developing health problems, or worsening existing health issues. For example, family and other unpaid caregivers of people with Alzheimer’s or another dementia are more likely than non-caregivers to have high levels of stress hormones, reduced immune function, slow wound healing, new hypertension and new coronary heart disease.

Spouses who are caregivers for the other spouse with Alzheimer’s or other dementia are at greater risk for emergency room visits due to their health deteriorating as the result of providing care. One 2006 study found that caregivers of spouses who were hospitalized for dementia were more likely than caregivers of spouses who were hospitalized for other diseases to die in the following year.

Underestimating the Odds of Disability – The Importance of Being Prepared (part 1 of 6)

Underestimating the Odds of Disability

No one likes to think about the possibility of their own disability or the disability of a loved one. However, as the statistics below demonstrate, we should all plan for at least a temporary disability. This post kicks off a series of posts in which I will take a look at the eye-opening statistics surrounding disability and some of the common disability planning options.

Most People Will Face At Least a Temporary Disability

Study after study confirms that nearly everyone will face at least a temporary disability sometime during their lifetime. More specifically, one in three Americans will face at least a 90-day disability before reaching age 65 and, depending on their ages, up to 44% of Americans will face a disability of up to 4.7 years. On the whole, Americans are up to 3.5 times more likely to become disabled than die in any given year.

Roughly 12% of the total U.S. population was classified as disabled in the  2010 census.  Especially surprising is the fact that more than 50% of those disabled Americans are in their working years (ages 18-64). In December 2012, for example, more than 2.5 million disabled workers in their 20s, 30s, and 40s received SSDI (disability) benefits, according to the Social Security Administration.

For Many, the Disability is Long-Term

Unfortunately, for many Americans the disability will not be short-lived. According to the 2007 National Home and Hospice Care Survey, conducted by the Centers for Disease Control’s National Center for Health Statistics, over 1.46 million Americans received long term home health care services at any given time in 2007 (the most recent year this information is available). Three-fourths of these patients received skilled care, the highest level of in-home care, and a majority needed help with at least one “activity of daily living” ( a category that includes tasks such as eating, bathing, getting dressed, or the kind of care needed for a severe cognitive impairment like Alzheimer’s disease). The average length of service was more than 300 days, and 69% of in-home patients were 65 years of age or older. Patient age is particularly important as more Americans live past age 65. The U.S. Department of Health and Human Services Administration on Aging tells us that overall numbers of Americans over 65 are increasing at an impressive rate:

The Department of Health and Human Services estimated that 9 million Americans over age 65 would need long-term care in 2015. That number is expected to increase to 12 million by 2020. I, for one, was especially shocked to learn that an estimated that 70% of all people age 65 or older will need some type of long term care services during their lifetime!

The Impact of Disability

The Council for Disability Awareness provide a metric called the PDQ, or “Personal Disability Quotient” which allows people to calculate their own risk of disability.  Here are a couple of startling examples:

“A typical female, age 35, 5’4″, 125 pounds, non-smoker, who works mostly an office job, with some outdoor physical responsibilities, and who leads a healthy lifestyle has the following risks:

  • A 24% chance of becoming disabled for 3 months or longer during her working career; with a 38% chance that the disability would last 5 years or longer, and with the average disability for someone like her lasting 82 months.
  • If this same person used tobacco and weighed 160 pounds, the risk would increase to a 41% chance of becoming disabled for 3 months or longer.

“A typical male, age 35, 5’10″, 170 pounds, non-smoker, who works an office job, with some outdoor physical responsibilities, and who leads a healthy lifestyle has the following risks:

  • A 21% chance of becoming disabled for 3 months or longer during his working career; with a 38% chance that the disability would last 5 years or longer, and with the average disability for someone like him lasting 82 months.
  • If this same person used tobacco and weighed 210 pounds, the risk would increase to a 45% chance of becoming disabled for 3 months or longer.

Visit the Council for Disability Awareness website at to calculate your PDQ.

Check back tomorrow for more about the risks for Alzheimer’s and the toll it takes on caregivers.

Five Myths About Medicaid’s Long-Term Care Coverage

While Medicare gets most of the news coverage, Medicaid still remains a bit of mystery to many people. The fact is that Medicaid is the largest source for funding nursing home care, but there are many myths about exactly who qualifies for it and what coverage it provides.  Here are five myths followed by the real story.

  1. Medicare will cover my nursing home expenses. Medicare’s coverage of nursing home care is quite limited. Medicare covers only up to 100 days of “skilled nursing care” per illness. To qualify, you must enter a Medicare-approved “skilled nursing facility” or nursing home within 30 days of a hospital stay that lasted at least three days. The care in the nursing home must be for the same condition as the hospital stay.
  2. You need to be broke to qualify for Medicaid. Medicaid helps needy individuals pay for long-term care, but you do not need to be completely destitute to qualify. While in general a Medicaid applicant can have no more than $2,000 in assets in order to qualify, this figure is higher in some states and there are many assets that don’t count toward this limit. For example, in Texas, the applicant’s home will not be considered a countable asset for eligibility purposes to the extent the equity in the home is less than $560,000. The house may be kept with no equity limit if the Medicaid applicant’s spouse or another dependent relative lives there. In addition the spouse of a nursing home resident may keep one half of the couple’s joint assets up to $120,900.00 (in 2017). For more information on Medicaid’s asset rules, click here.
  3. To qualify for Medicaid, you should transfer your money to your children. Medicaid law imposes a penalty on people who transfer assets without receiving fair value in return. This penalty is a period of time during which the person transferring the assets will be ineligible for Medicaid, and the length of the penalty period is determined, in part, by the amount of money transferred. The state will look at all transfers made within five years before the application for Medicaid. That doesn’t mean that you can’t transfer assets at all — there are exceptions (for example, applicants can transfer money to their spouses without incurring a penalty). However, before transferring any assets, you should talk to an elder law attorney. For more information on Medicaid’s asset transfer rules, click here.
  4. A prenuptial agreement will protect my assets from being counted if my spouse needs Medicaid. A prenuptial agreement only works to keep property separate in the event of death or divorce. It does not keep your property separate for purposes of Medicaid eligibility.
  5. I can give away up to $14,000 a year under Medicaid rules. You can give away up to $14,000 a year without incurring a gift tax. Under Medicaid law, a gift of $14,000 or any other significant amount could trigger a penalty period if it was made within the five-year look-back period.

Before applying for Medicaid, it is crucially important to consult with your elder law attorney!


The Costs of Dementia

Most of us know of someone who has been diagnosed with dementia. It is a costly, heart-breaking and life-altering syndrome that is nearly doubling in numbers of people affected worldwide every 20 years . Dementia has affected the likes of Norman Rockwell, E.B. White, Rita Hayworth, Charlton Heston, Ronald Reagan, Charles Bronson, Margaret Thatcher and many other well-known people. It does not discriminate based on station in life, and its effects are widely dispersed.

What is Dementia?
Dementia is a general term for a decline in mental ability, severe enough to interfere with daily life. Memory loss is one such example. Alzheimer’s is the most common type of dementia. Symptoms of dementia can vary greatly, but is diagnosed when at least two of the following core mental functions are significantly impaired: memory, communication and language, ability to focus and pay attention, reasoning and judgment, and visual perception.

These symptoms can be displayed when the person with dementia has problems with short-term memory, keeping track of his/her purse or wallet, paying bills, planning and preparing meals, remembering appointments, or travelling out of the neighborhood. These often progressive symptoms will likely eventually necessitate assistance with daily activities, resulting in increased expense and stress on the individual, their family members, and society at large.

The RAND Study
In 2013, the RAND Corporation recently concluded a nearly decade-long study on close to 11,000 people. The study sheds light on dementia statistics including rates of diagnosis and costs to society. The results of this study were published in the New England Journal of Medicine in early April 2013. The study’s reliability is significant—it was led by an independent, non-advocacy group and financed by the federal government.

The Cost of Dementia to Society
According to the RAND Corporation’s study, the cost of caring for those with dementia is projected to double by 2040 and is currently higher than caring for those with heart disease or cancer. The direct costs of dementia, including the cost of medicine and nursing homes, was $109 billion a year in 2010 compared to $102 billion for heart disease and $77 billion for cancer. This cost is pushed even higher, to $215 billion, when support from family members or other loved ones is given a cost value. This figure will rise to $511 billion by 2040. Information from the RAND study and from the Centers for Medicare & Medicaid Services indicates that, by 2020, dementia patients will account for about 10% of the elderly population while direct medical spending on them will equal about 17% of all spending projected for Medicare and Medicaid devoted to the aged .

The Cost of Dementia to the Family
While the cost to society is great and will likely have a substantial impact on all of us, the costs to individuals diagnosed with dementia and their loved ones is even more significant. As evidenced by the RAND study, each individual case of dementia costs between $41,000 and $56,000 a year. In addition to the financial drain on families, dementia increases the stress on the caregiver loved one. In fact, caregivers have been found to be at increased risk for depression and anxiety and long term medical problems, which impose a further financial burden on the family.

Dementia poses higher costs to society and individuals than heart disease or cancer and these costs are projected to continue rising. Most significant is the cost of care for the patient with dementia. The dementia-ridden person will progressively need more and more help with daily activities and this is the biggest cost of the debilitating syndrome. With the proper attention given to improvements in medicine with regards to dementia, society will be able to get a handle on this costly condition. And, with help from an Elder Law attorney, the family of those afflicted with dementia can obtain the support they need to care properly for their loved one.

Helping clients prepare or deal with an immediate need to find appropriate resources in dealing with dementia is the core of my practice. I can support caretakers in making sure their loved one has access to the care and medical attention they need. Please contact me if you or a loved one who has been diagnosed with dementia or is at risk for developing this debilitating syndrome. I would be honored to help.

***The Wall Street Journal, Dementia Will Take Toll on Health-Care Spending, April 8, 2013
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