Life Enrichment
A plan for life

A plan for life

Explore the options for healthy, happy long-term care
By Amy Meadows

When you think about planning for your advanced years, your mind probably wanders to all of the wonderful things you’ll be able to do during your retirement. Spending time with family and friends. Traveling to new and exciting locales. Maybe even taking a personal-development class or two. But there’s probably one thing you try not to think about—the possibility that you may require long-term care one day. And this often-unforeseen turn of events should actually be at the top of your list as you formulate a plan for your future.

“Americans are living longer lives these days. Living into your 70s or 80s is common, and many people even see their 90s or 100s,” says Jesse Slome, executive director of the American Association for Long-Term Care Insurance. “With this longer life span, chances are that you will need some type of long-term care.” In fact, according to the Long Term Care Insurance National Advisory Center, the number of Americans needing long-term care by the year 2030 will reach more than 23 million, with long-term care costs reaching $300,000 annually per individual.

Whether you become chronically ill later in life or simply need medical or personal care that’s associated with aging, having a strategy in place will allow you to face whatever comes with dignity and aplomb. Of course, devising a plan for long-term care is complex, as there are a number of issues you need to address, from where you’ll live to how you’ll pay for your care. And the earlier you educate yourself about your options and lay the groundwork for your long-term care, the better.

“By planning ahead, you can find the quality of care and quality of life that you desire in a long-term care facility for yourself, loved one or other person,” say the experts at, a collaboration between the American Health Care Association (AHCA) and the National Center for Assisted Living (NCAL). “Planning ahead will also make the transition easier because many important decisions will already have been made or at least discussed.”

Give me shelter

Independent Living vs.
Assisted Living

With so many different terms being used to describe the residential opportunities available for seniors, it can be easy to get confused. For instance, is there a difference between “independent living” and “assisted living”? Yes, there is. According to, independent living in a retirement community requires residents to be able to manage their own home and personal needs and does not offer health services onsite, while seniors who opt for an assisted-living facility will receive some custodial care, such as help with bathing, dressing, grooming and eating, as well as access to health services.

If the time does come when you require long-term care, where you live will actually depend on the level of care you require. As detailed on The Mayo Clinic Web site,, you have several options available to you as you consider your possible housing needs, including home care, assisted living, a nursing home or a continuing-care retirement community (CCRC).

  • Home care. Needing long-term care does not necessarily mean that you have to leave the comfort of your own home. The National Association for Home Care & Hospice reports that 7.6 million individuals receive care at home “because of acute illness, long-term health conditions or terminal illness.” The level of in-home care can vary from a nurse who comes to your home on a regular basis to attend to your medical needs to a home health aide who can visit daily and help you bathe, get dressed, complete housekeeping tasks and more, according to the experts at The Mayo Clinic.
  • Assisted living. If you have long-term care needs but want to maintain a certain level of autonomy, then an assisted-living facility might be an ideal option. NCAL defines assisted living as providing independent seniors with “assistance and limited healthcare services in a home-like atmosphere.” Those services include 24-hour protective oversight, food, shelter and a range of quality-of-life amenities. As Lisa Gelhaus, director of public affairs for NCAL, explains, “Assisted living provides person-centered care that preserves and maintains an individual’s dignity, respect and quality of life. Assisted-living residences provide assistance with physical activities and health-related needs, yet they also strive to meet the social, emotional, cultural, intellectual and spiritual well being of residents.”
  • Nursing home. A nursing home is probably the first type of housing you envision when you hear the phrase “long-term care.” Of course, the idea may not appeal to you, possibly because of the negative stories often reported by the media about substandard nursing-home facilities. However, if you choose the right one for you, a nursing home can provide a suitable level of 24-hour medical care and be particularly beneficial if you are recovering from an illness or injury and require rehabilitation services. The Mayo Clinic also notes that nursing homes, unlike other long-term care housing options, offer end-of-life care.
  • Continuing-care retirement community (CCRC). Offering senior-housing apartments, assisted living and a nursing home all in one setting, a CCRC seems to offer the best of all possible worlds. As the level of care you need increases, you can simply move from one facility to another within the same community. However, according to AARP, CCRCs can be quite expensive and often require an entrance fee and monthly payments; in addition, the organization observes that “some CCRCs are affiliated with a specific ethnic, religious or fraternal order, and membership may be a requirement.” So, while this housing alternative offers lifetime shelter and care, you’ll have to do some research to see if this option is available to or feasible for you.

Money matters

The financial issues surrounding long-term care often are the most difficult to grapple with. “Long-term care is the largest financial risk that Americans face in their retirement years,” Slome asserts. The risk is related to the fact that people don’t prepare themselves to pay for long-term care because they do not fully understand the costs associated with it. And while you may have savings set aside, those funds may not be enough to cover prolonged care and eventually could run out when you need them the most.

Furthermore, Medicare will not pay for long-term care, including assisted living—it only covers a medically necessary skilled-nursing facility or home healthcare, and you must meet certain stringent conditions to qualify for this type of aid. “There is a common misconception that Medicare pays for assisted living. Although Medicare pays for medical services such as doctor visits, hospital stays, therapies, home health and prescription drugs that an assisted living resident needs, Medicare does not pay for assisted living,” Gelhaus says. “In addition, Medicaid, a state-federal program, is a limited but growing form of coverage for assisted living, and a majority of states offer Medicaid coverage for assisted-living services to people with low incomes. However, nationally out of the 1 million people estimated to be in assisted-living residences, only about 131,000 people are receiving benefits through Medicaid, according to a recent NCAL study. In addition, Medicaid does not pay for room and board—it only covers the care services provided to individuals.”

However, one way to guarantee that you can finance your long-term care is to purchase long-term care insurance. “Long-term care insurance allows you to pay your bills and avoid the stress that families must endure when dealing with these costs,” Slome states. “The financial issues of long-term care can devastate a family. This is the one way you can avoid being a burden to your family—something no one wants to be.” Fortunately, the long-term-care insurance industry has developed a wide array of products in recent years, allowing you to choose coverage that you can afford today and will protect you tomorrow; you can even purchase some coverage now and add to it later. What’s more, Slome notes that having long-term care insurance also gives you the freedom of choice because you can spend the money you access in the way that best fits your particular needs, whether it involves in-home care or moving to a long-term care facility.

The key to buying long-term care insurance, though, is purchasing it well before you reach the age when you’ll probably need it. “Individuals mistakenly think long-term-care planning is something that can wait until after retirement, but because of health changes that tend to occur in our 50s and early 60s, the facts show otherwise,” Slome explains. “A recent study revealed that, in 2008, between 20 percent and 33 percent of individuals who submitted an application for long-term care insurance between ages 60 and 69 were declined coverage because of an existing health condition.” On the flip side, many companies reward applicants who seek coverage when they’re in good health with discounts that can reduce the cost of long-term-care insurance by 10-20 percent annually, amounting to hundreds of dollars in savings each year.

“When it comes to long-term-care insurance, the problem is that you can’t get it when you need it,” Slome adds. “It’s the same as with other types of insurance—you can’t buy car insurance right after you’ve had an accident, and you can’t purchase flood insurance when a hurricane is heading your way. You can’t start saving for retirement at age 64 and expect to have enough money to last. As they say, a failure to plan is a plan for failure.”

Get Educated

Check out these Web sites for more information about long-term care:

Know the costs

Understanding the costs associated with long-term care is critical when it comes to your planning process. The following figures from the American Association for Long Term Care Insurance represent the long-term care costs specific to the Atlanta area:

  • Home Health Aide—Average Hourly Rate: $18
  • Homemaker—Average Hourly Rate: $17
  • Assisted Living—Lowest Monthly Cost: $1,400
  • Assisted Living—Highest Monthly Cost: $4,350
  • Assisted Living—Average Monthly Cost: $2,800
  • Nursing Home—Semi-Private Daily: $150
  • Nursing Home—Private Average Daily: $175

Broach the subject

The topic of long-term care might not be one you want to bring up at the dinner table, but it is a conversation you should have with the important people in your life, whether it’s your spouse, your children or other close individuals. Bringing the subject up can be intimidating at first, and it could evoke an emotional response that you didn’t expect. Just remember that while you may feel uncomfortable talking about long-term care right now, you—and your family—will be glad you did. The experts at conclude, “The best scenario is one where all parties realistically evaluate both the current situation and how it may change in the short- or long-term future. Ideally, being proactive will help everyone arrive at a mutual decision that is the best solution.” And the first step is to open a dialogue so you can discuss your wishes. When you do, you’ll be able to find comfort in the fact that you’re ready for whatever lies ahead.

The conversation: myth vs. fact

According to Financing Long Term Care: A Resource Center for Families, an initiative from the University of Minnesota Extension Service, there are a number of myths associated with long-term care planning. Here are just a couple of the misconceptions and the corresponding truths, as found on the Center’s Web site,

Myth: Only one person in the family needs to be protected.

Fact: It is very important that families plan together for their long-term care needs. There are many decisions about income, assets and financial security that spouses/partners, adult children and other family members need to consider. The effect of one person’s long-term care needs on other members of the family or a partner needs to be part of the planning equation.

Myth: Family members will all think alike regarding who should pay for long-term care.

Fact: It is very common for spouses, partners, parents and adult children to think quite differently about who should pay for long-term care. Is financing long-term care a family responsibility, a role of government or private insurance? Does family responsibility include unpaid caregiving as well as financial expectations? Taking time to talk about different expectations and beliefs can help avoid misunderstandings, wrong assumptions and conflicts.

Myth: Most families talk openly and easily about financing long term care.

Fact: Only half of adult children have discussed long-term care with their parents, and even fewer parents have discussed long-term care with their adult children. It is clear that the lack of family discussion on the topic of long-term care is a significant challenge to long-term care planning. Talking about long-term care involves facing issues of death, dying, decreasing independence and money—all of which can be taboo topics in families


Long-Term-Care Planning Do’s and Don’ts

Do include your loved one in making the decisions if at all possible. Talk openly about concerns, making him or her feel part of the process. It is important to differentiate between serious health risks and honest differences of opinion. Continuously remind your loved one you are there to work with—not against—him or her.

Do start paying attention to daily activities and observe any declines in health and mobility issues, personal hygiene, paying bills, taking care of pets, driving, memory issues, etc. Focus on strengths but pay close attention to weaknesses.

Do seek professional help when putting a plan into action. If necessary, bring in a third party whose opinion your loved one respects, whether it’s a clergy person, medical and/or legal professional, friend or family member. Create open dialogue about his or her safety and well being. Get financial and legal guidance to help make the best decisions available.

Do take advantage of enlisting help from others. Ask for help from family, friends, volunteer organizations, neighbors or trained caregivers. Many companies provide assistance through an employee-benefits program or human resources. A team effort will help reduce feelings of guilt and anxiety. We are much more effective when surrounded by a strong support group.

Don’t avoid planning and open discussions with your aging loved one and waiting until a crisis occurs, then acting from panic mode.

Don’t take on more than you can handle. Set boundaries and acknowledge that care-taking responsibilities can change everyone’s life dramatically. Strive to maintain respect for each other as plans are made.

Don’t wait for an accident to happen. For example, there are safe-driving courses available for your loved one to take when considering having them no longer drive or limiting their driving. Universal design of homes for safety is important to prevent falls and potential problems.

—Hillary Abrams, director of client services for Companion Care of America, a state licensed home-care company in the metro-Atlanta area, andauthor of Aging Parents and Options in Care-A Simple Handbook