Some conversations are really hard to have. Especially those related to our, or a loved one’s, end of life. Most people are hesitant to have the “talk.” I call these “3D” conversations as they are subject to denial, delay, and deflection. Let’s have one.
In the vast majority of couples there will be a survivor, one who lives longer than the other. The survivor probably has been a caregiver for the other half of the couple: possibly the primary, if not only, caregiver. If she is the last one standing, how will she get the care she needs?
That is the dilemma for many families; dad has passed and mom needs care that was never adequately planned or prepared for. If there are children, caregiving becomes their responsibility (either to give the care or pay for care by professionals).
To jog our memories, we are talking about long-term care, which is assistance with the “activities of daily living” (eating, bathing, dressing, transferring from bed to chair, toileting, and continence). This care may be at home or in a facility.
Medicare does not pay for long-term care beyond a few weeks in a skilled nursing facility after an inpatient hospital stay and if there is a medical necessity for skilled nursing and the patient is improving. MediCal (California’s version of Medicaid) does have a long-term care program for impoverished persons as a “safety net.” Qualifying for MediCal benefits essentially eliminates the recipient’s estate.
Well, now that we are depressed having identified the problem, let’s talk solutions.
The first solution is to plan early (your 50’s is not too early, 70’s is not too late) by starting with the needs of the survivor and working backwards through the needs of the couple together. In today’s world there are various forms of long-term care insurance that can be purchased individually or jointly by couples. The earlier this coverage is acquired, the less expensive it is. Additionally, the younger the applicant is, the healthier they tend to be, so qualification for the coverage is usually easier.
As an aside, it is not unheard of for a person in their 30s to purchase long-term care coverage. Why? The premiums are comparatively low. Plus, a significant portion of the long-term care benefits paid out are to policy-holders who are under 65 and have suffered a medical condition (i.e., car accident or early stroke) which requires long-term care for a period of time.
Back to the issue at hand: what if the couple is older or one of them has already passed? There are still things that can be done, depending on the individual’s situation. There is a program in California that protects some assets from MediCal “spend down” requirements called the California Partnership for Long-term Care. That may be an option. There is also a special long-term care annuity that may be suitable.
The best way to proceed is to contact a long-term care coverage professional and discuss your personal circumstances. If this doesn’t apply to you, but you know someone who might need some advise, pass this on to them. In our case, there is never a charge for these consultations.