Whenever I sit down with clients to plan ahead for Medicaid eligibility we spend a lot of time walking through the worst-case scenario of permanent nursing home placement, thereby triggering approximately $12,000 per month in nursing home fees (Connecticut is the 2nd most expensive state in the U.S. when it comes to nursing home care). But it's also important to at least consider the possibility that the client will never actually need to be placed in a nursing home.
There is no "crystal ball" to use and nothing can be guaranteed but there are factors to consider when trying to determine the odds that you will need permanent nursing home placement at some point in the future.
Is there a history of dementia and/or Alzheimer's Disease in family? It seems like these are the types of conditions that most often trigger the need for long-term, permanent nursing home placement and they are very hereditary. Other issues like diabetes, a heart condition, a bad hip etc. can usually be handled adequately at home.
Do children, grandchildren and other family members live nearby or are they beyond driving distance from your home? The larger the local support network (usually a family-based network) the less likely that you will need to be permanently institutionalized.
How extensive are your liquid assets? Even if you don't have long term care insurance in place, the more you have in investments, bank accounts, retirement accounts, etc., there is a greater possibility that you will be able to provide yourself with home health care and/or companionship to keep you in the community.
I always advocate for planning for the worst (in this context, permanent nursing home placement) and hoping for the best. However, you need to realize that future nursing home placement is not a "given", and if the chances of requiring institutionalization are remote based on your own set of personal circumstances then you should factor that into your planning.
DISCLAIMER: This blog does not offer legal advice, nor does it create an attorney-client relationship. If you need legal advice, consult with a lawyer instead of a blog.
I generally consider comprehensive long term care insurance as "Plan A" when it comes to protecting your assets from a future nursing home placement. One benefit of this approach which is often overlooked is the ability to deduct the premium payments for income tax purposes...to a point.
Here are the 2014 income tax deduction limits for long term care insurance premiums:
Whenever I'm called upon by the Probate Courts to act as a conservator for an elderly person my natural instinct is to always do whatever is necessary to allow the person to live at home for as long as possible.
But Howard Gleckman's article reminds us that it ain't quite that simple. Living at home is no cakewalk in most cases, particularly when it comes to addressing social issues.
It's a little challenging to digest all the moving parts of the current proposals for health care reform. But one aspect of the Senate Finance Committee's proposal kinda jumped out at me: the "Community First Choice Option".
This option provides partial federal Medicaid reimbursement to states that establish community support programs for people with disabilities. Such programs would only apply to people who require an institutional level of care, caps on the number of people under the program would not be allowed, nor would waiting lists for services.
Please note that the proposal does not make programs for home health care mandatory and it provides funding only for the next five years. Nonetheless, this certainly falls under the "step in the right direction" category!
Click here for more detailed information on the proposal from the National Coincil on Independent Living (NCIL).