Most of us hope to be able to care for ourselves without assistance for the rest of our lives, but the facts are that “someone turning age 65 today has almost a 70% chance of needing some type of long-term care services and support in their remaining years” This statistic is sobering if you consider the reality of the likelihood of needing long term care assistance sometime in your future. 

When it comes to growing older, the one thing we can do to help ourselves and others is to make plans before we need help. Let’s take a look at the many options available for those needing long term care 

Staying Home

Many older people want to stay in the home they have lived in for decades. Often, this feels comfortable and familiar. There are problems with this arrangement however. Extra expenses come in the form of a house that needs to be upgraded for handicapped living or having no bedroom on the main floor. There are yards that need to be mowed and roofs that need fixing. There are utilities to pay, groceries to buy, food that needs to be cooked. Often the elderly person cannot handle the day to day of what needs to be done so it becomes expensive to hire for the services needed while living at home.

Home Health

Home Health is a term used to describe temporary services that are prescribed by a doctor to give you time to heal from a health event such as a surgery when you get home from the hospital. This type of care is at home and often insurance will cover this basic level of care that usually just involves a PT or OT helping with a bath or with physical therapy

Home Care

Home Care is a term that explains a long term care arrangement in your home. Usually, you determine how many hours per week you need and there is no doctor prescription required. Home Care Aides are available to help with dinner preparation, medication administration, some light housekeeping, and some pet care. 

A higher skill level caregiver is hired to help with activities of daily living (commonly called ADLs) including bathing, moving around, and help with behavioral habits. 

Often you can find caregivers with certifications for all kinds of caregiving levels at agencies. WIth an agency caregiver, you also have flexibility if your caregiver is ill or has to be out of town. They have the ability to send a substitute caregiver. They also interview and do background checks, drug testing, and have liability insurance to cover any issues that might arise in the job situation.

If you have serious medical needs such as IV’s, trachs, wound care, diabetic insulin blood draws, etc, then you would need to hire an RN who would know how to handle these types of complicated health issues.

Your level of care is determined by who you hire. In the triangle area, a privately hired caregiver might be $13-20 per hour. Hiring from an agency provider for a caregiver with certifications might be up to $28 per hour. A skilled nurse runs anywhere from $50-100 per hour. 

Medicare Advantage has started to pay for some of this type of care, but generally this is private pay care. Health Insurance does not cover long term care.

Adult Day Care

An option that is cheaper than Home Care is Adult Day Care. This gives the normal caregiver a break and these centers often offer care, snacks, meals, group activities & entertainment. Some even offer showers to help with care. 

Care Managers

Care managers are a relatively new phenomenon where a family hires someone to manage all aspects of care for you. Care managers attend doctor appointments and listen, take notes, and ask pertinent questions. They interface with the family about what is best for your living situation and handle any living arrangements you may have while also handling any government bureaucracy issues and insurance battles. They are generally like a family member in their role when family cannot be there. Hiring a care manager runs from $100-150 per hour.

Independent Living

Independent living arrangements are apartments or homes that are part of a larger retirement community of homes. However, there is no house upkeep and all amenities are included.  TV, Phone, Internet, senior activities and events, housekeeping, transportation to doctor appointments, and to the grocery store are all included along with outings to fun places in the total monthly price. 

This type of environment can provide emotional & social support for seniors who would be lonely and disconnected at home. It also provides a level of security for those who have no relatives close by to check in. 

There are no CNA’s or RN’s on site. However, supportive health services can come in and provide “age in place” care. These types of arrangements are all private pay and run from $2800 to $6000 per month.

Assisted Living

With assisted living, everyone’s health is assessed when they move in. A nurse oversees your care and works there full time. A CNA is there at all times around the clock for other types of care. The meals are centered around nutrition for health conditions and include diets such as no sugar or low sodium. Caregivers handle all medication administration. Transportation is provided when needed. Usually there is a separate area where patients with mental health issues stay where the doors are locked so that they do not leave and hurt themselves.

These beds are mostly private pay, but there are a couple beds allotted for Medicaid patients who do not have enough to pay anything. Most patients they accept for Medicaid are in the process of spending down their assets. Others have income that is paid monthly to the assisted living center along with Medicaid funds.

Assisted Living costs from $3500-10,000 per month even with sharing a room with a roommate.

Skilled Nursing Community

These types of facilities are usually for short term stays so that someone can rehabilitate from surgery such as a joint replacement. Nurses are there 24/7 and insurance usually covers short term stays. Medicaid or long term care insurance can sometimes cover this also. 

For long term stays due to extra needs such as continuous blood monitoring for insulin, or IV therapies or wound care, this type of arrangement is generally private pay.

Continuous Care Retirement Communities CCRC

In a CCRC, every level of care you need is there. You buy a home or apartment in the community and move there before you need any care. Usually you also pay an entrance fee of between $100,000 and $1,000,000 in addition to buying your home. There are premium services and activities including ballrooms and grand dining rooms. There is a higher level of care than other types of centers and you stay there as you age and with any conditions you may develop.

Find Help

If you are overwhelmed by the possibilities for long term care or unsure of how to make a plan for your future, contact an experienced estate planning attorney. We work with the legal documents necessary to make these decisions before you actually need them. Don’t let time get away and let your long term care plans get left up to chance. There are ways to maximize your assets while still planning for long term care. We want to walk you through what is possible.


Options for Seniors: Long Term Care Planning

Also check out our webinar on this subject where we discuss the pros and cons of each type of senior living arrangement and how to make the best decision for your particular situation with Barbara Patterson, an expert in long term care options. We will also look at the legal aspects of the types of arrangements available and how this affects your estate.


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