Growing older, caring well — part 2 of 4

Growing older, caring well — part 2 of 4

Most adults not financially prepared for costs of long-term health care

By Martha Simmons
Correspondent, The Alabama Baptist

Most Americans look forward to longer life spans but haven’t prepared for the high likelihood they’ll need a lot of help to live at least some of those extra years.

Research says that almost 7 of every 10 of us will need long-term care at some point in our lives and for an average of three years. Yet few of us have any idea of what that might cost nor have we saved or otherwise prepared for it.

High price tag

Drawing from more than 15,500 surveys in 440 regions throughout the United States, the annual Genworth Cost of Care Survey 2018 indicates there’s a high price tag on long-term care even in the home.

While Alabama’s long-term care seems a bargain compared with national costs, it’s important to note that the median annual income here is lower too: $48,123 in our state versus $60,336 nationally, according to the U.S. Census in 2017. 

That said, how do any but the wealthiest families afford to pay for a year of long-term care, much less the average three years … or even more? 

The three primary sources of funding for long-term care are the following:

1. Long-term care insurance

Long-term care (LTC) insurance is available but at a significant price, according to AARP. 

“Premiums for LTC policies average $2,700 a year, according to the industry research firm LifePlans,” AARP writes. “That puts the coverage out of reach for many Americans. (One bright spot for spouses: Discounts for couples are common — typically 30 percent off the price of policies bought separately.)”

2. Medicare

According to Genworth, Medicare will cover 100 percent of your costs for only the first 20 days in a skilled nursing facility, hospice care or home health care, and then only if you:

  • Had a recent hospital stay of at least three days
  • Are admitted to a Medicare-certified nursing facility within 30 days of the hospital stay
  • Need skilled care such as physical therapy or nursing.

For days 21–100, you pay your own expenses up to $167.50 per day and Medicare pays any balance. After 100 days you’re on your own.

3. Medicaid

If you have a low income and limited personal financial assets you may qualify for Medicaid to pay for health services and nursing home care. 

“For eligible beneficiaries Medicaid pays the full cost of room and board in a nursing facility, plus any therapies that are part of the nursing home’s regular resident care. 

“Medicaid’s payment also includes personal care items such as incontinence supplies and toiletries, as well as services such as bathing, grooming and laundry,” according to “There’s no time limit on Medicaid nursing home coverage. And the Medicaid beneficiary has no co-payments to make.”

Out of concern for what might happen to assets shared by a couple if one spouse requires costly skilled care and the other will remain at home many seniors take steps in advance to qualify for Medicaid-supported long-term care by deeding their homes to their children and divesting themselves of other financial resources. 

There’s a catch though: Such measures must be taken at least five years before applying for Medicaid-supported long-term care. Anything sold, given away or otherwise transferred during this five-year “look back” period by either the applicant or spouse could be cause for disqualification or penalty. 

Special rules for these situations apply. For details download a copy of “Tips for Applying for Institutional (Nursing Home) Medicaid”  ( and other forms on 


Talk about health care wishes before a crisis occurs, experts suggest

As parents or other loved ones age financial questions about their future care can loom large. They loom even larger if you’ve never been able to have a conversation about what their financial situation is like or what their wishes are for the future.

If you’re in that boat you’re not alone — most people avoid this conversation until they have to. For the children it may be an attempt to dodge conflict or avoid seeming greedy or bossy. For the parents it may be hard to admit they need help or aren’t financially prepared for the future, if that’s the case.

Strong data

But PBS reported in 2017 that there’s good, strong data to support having this conversation as early as you can. For one, it helps with emotions — you can pick a time when your loved ones are happy and relaxed, not stressed or forced into making decisions. More than 80 percent of long-term care decisions are made during a medical crisis, and usually in these situations some type of long-term care is needed.

But not only does having the talk in normal times make for a better conversation — it helps with preparation
and the need for preparation is staggering. Half of nursing home expenses are paid out-of-pocket by families these days, with adult children contributing an average of $10,000 a year to their parents’ care, according to eldercare expert Barbara McVicker.

It’s worth talking as early as possible about how your family will afford that. With that in mind consider these things as you start the conversation:

1. Approach the topic in love.

If at all possible have the conversation in person.PBS recommends starting the talk with a request like, “I know this might be difficult for you to talk about, but I care enough about you to want to make sure you’re taken care of as you age. Can we find a time to discuss what plans you have made and how I might be able to help you in making sure everything is taken care of?”

Framing the question this way shows them you care and also gives them time to process what you’re asking.

2. Take your time.

If you start having financial conversations early enough, you won’t have to get all your questions answered at one time. Engage in shorter conversations spread out over time rather than one long conversation where emotions can get high or the topic can get overwhelming.

3. Slowly cover the important things.

Talk through your loved ones’ expenses and find out what plans they may already have in place. Then work together to build a strategy for how to care for their living expenses and medical needs as they come up. Do they have insurance that could help them cover the costs of staying home as they age? Are they open to moving to any type of retirement community with continuing care?

As you ask these questions along the way find out how to locate their important documents if they’re ever needed — things like their doctors’ contact information, will, health insurance or Medicare information, birth certificates, power of attorney, advanced directives and mortgage information.

4. Get some help if needed.

Have they got a fixed budget, or have they planned ahead for their long-term care? These are some questions you’ll eventually need the answer to, but if it gets uncomfortable or you would like some help figuring out what’s needed, consider reaching out to a financial coach or someone local who’s an expert in fiduciary matters.

Help from an attorney

For Terry Finch that meant talking with an eligible attorney as he helped his mother, Sylvia, make plans.

“One of the things … that was most helpful was to meet with an elder care attorney to get our questions answered about how and when to utilize private funds and how qualifying for Medicare/Medicaid would impact Mom,” said Finch, whose mother now lives at the Oaks at Parkwood, a Noland senior living provider in Bessemer. (TAB)


First Person: George says ‘too soon’ is better than ‘too late’ to make senior housing decisions

David George, president of WMU Foundation, and his wife Allyson recently moved to the Oaks on Parkwood, a senior living community in the Hoover area. Here he talks about what went into making that decision.

I have learned it is better to move too soon than too late. We had hoped my dad and mom could have moved together into independent living. Unfortunately his dementia had progressed to the point we had to move him into memory care without Mom. It was the right decision … but if they had moved a year or two earlier they could have made the move together.

Thankfully a year or so after Dad died, Mom was able to move to independent living at the Oaks and has been here for about eight years now. Eight good years!

Last year I realized that life was moving faster than I could handle for my wife and me and we had a decision to make.

The first thing I considered was a campus that had all levels of care from independent living, assisted living, memory care to skilled nursing care.

We made the decision to move into an independent home here too. 

It allowed us to downsize (actually right size) to a beautiful home that is within walking distance of my mom’s independent living apartment and opened the door for the services and resources that my wife and I need now and into the future.