The Elder Care Journey
By Rick Law of Law Elder Law. Serving Seniors, Boomers, and Their Families in West Suburban Aurora, IL Just off the I-88 tollway. The “Elder Care Journey” is a continuum of possible care needs that get more intense as the journey progresses. Typically, the journey progresses as follows:
- Healthy, vigorous senior – Most of today’s seniors are active, much more so than in years gone by. Several decades ago, you were not apt to see seniors playing tennis, running in races or skydiving! But with today’s medical technology and more resources for exercise for health-conscious seniors, more people in their sixties, seventies and even eighties are living full and active lifestyles… at least for a while.
- Medications and acute health problems – At some point, it is likely that even a healthy and vigorous senior will begin to experience some type of health issues. These issues may start small, with arthritis or high blood pressure. But over time, most seniors will begin to exhibit more serious signs of physical aging and the onset of more serious issues, possibly resulting in hospitalization to recover from injuries or for the purpose of various surgeries. It is at this stage in the journey that these issues – and the corresponding medications that are prescribed – will most likely be covered from a cost standpoint either by Medicare (which covers acute care) or private insurance. Although the senior may be responsible for paying an insurance deductible, these costs are often capped at an annual rate, so the senior can plan and anticipate their healthcare financial responsibilities. In addition, those who are covered by Medicare may also have a Medicare supplemental insurance policy that covers many of the copayments and deductibles that Medicare does not cover.
- Declining senior with memory or mobility issues – As the senior progresses on the journey, memory and/ or mobility will begin to decline. Regardless of how active or healthy one was in the past, at some point the body and the mind will begin to slow down. These issues may start small, such as frequent forgetfulness or walking at a slower pace, until eventually the senior may need some type of in-home assistance to help with basic daily needs.
- In-home assistance – When a senior is unable to perform basic daily living activities – either physically or because they cognitively are unable to remember to do so – then some form of in-home care is needed. This could entail hiring a homemaker aide to help with household chores or bill paying, or more extensive assistance might be needed on a more regular basis. Regardless of the need, at an average cost of $17 to $22 per hour (eight hours per day x 365 days per year = $49,000 to $64,000 per year), the expenses can begin to add up. It is now that the senior and their family may begin to realize that regular health insurance, as well as Medicare and Medicaid, are not constructed to pay for these types of care costs. In fact, it is often only personal assets or long-term care insurance that will cover these types of expenses. And, unless the senior is suffering from a very serious condition, the situation could go on for years.
- Assisted living facility – A time comes when the senior is unable – or unsafe – to live at home without assistance throughout the day and night. At this time, even though the senior may not need medical or skilled nursing care, the family will need to consider an assisted living facility. Here the senior will still maintain a great deal of independence, yet will have access to care and assistance whenever needed. Here again, these costs are not covered by Medicare or regular health insurance policies. Payment for this type of care requires paying out-of-pocket or using long-term care insurance. (In Illinois, we do have “supportive living facilities” that take Medicaid, but you must meet the financial requirements and pass a screening that shows you require a certain level of care. All “assisted” living facilities are not “supportive” living facilities; and therefore, Medicaid is not an option in the traditional independent or assisted living facility.) With an average monthly cost of $3,000 to $6,000 and an average length of need of two and a half to three years, the annual cost for an assisted living facility is $36,000 to $72,000 per year. Here again, the potential to quickly deplete personal assets is high without some form of pre-planning for this need.
- The fragile senior at a nursing home resident – Once the senior’s health deteriorates to a certain level, they will have no choice but to enter a nursing home where they can receive around-the-clock skilled care. Skilled nursing facilities are equipped to handle most conditions, and many even have a special section for patients with Alzheimer’s disease. The average monthly cost of care in a skilled nursing home facility is $4,000 to $9,000, with an average length of stay two to five years, with the only real option for payment coverage being out-of-pocket, Medicaid – but only if the senior is considered to be at the state’s poverty level – or a long-term care insurance policy.
- Death – When the senior has passed away, a whole host of other issues will come into play. This can include survivor care, if the senior was married and is leaving behind a spouse, as well as estate administration. Pre-planning in this area is also essential, as the senior’s estate could be subject to hefty estate taxes, and his/her heirs could end up with nothing to show for a lifetime of work and saving by the senior.