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Transitions in care as we age: a guide to options

by Amanda Lambert | Contributor
March 18, 2020


Most people don’t think about needing more care as they age until it happens. An AARP report shows that 76% of people 50 and older say they want to age at home. How is this accomplished? Whether you are retired, or planning for retirement, understanding the basic concepts of care can avoid stress and increased costs later. Part of any advance estate planning should include a basic comprehension of these terms. Safety, health and financially supported longevity are at the core of these concepts. Let’s take a look at each.

What is home care?

An illness or accident can have a significant impact on someone’s life. It may be temporary or cause a permanent need for continued help to remain safely at home. The term home care encompasses both medical home health and personal care services. The two differ in terms of who pays and what tasks they can provide.

Home health

  • Home health is a medical service. Home health can provide nursing, occupational therapy, physical therapy, speech therapy and aides.
  • A physician’s order is required.
  • In most cases, home health is time limited.
  • Home health is covered by traditional Medicare, Medicare Advantage plans and Medicaid.
  • A patient must be “home bound” to qualify. They are unable to drive and it would take a significant effort to leave the home.
  • A typical scenario would be nursing once a week, PT or OT two to three times a week and aide service three times a week.
  • Home health can be used in assisted living as well as at home.

Personal care or private duty

  • Sometimes home health doesn’t cover the gaps in care and more help is needed. Under Medicare guidelines, home health staff cannot provide transportation, meals or housekeeping.
  • Personal care is paid by the patient. Costs range from $20-$40 an hour depending on the number of hours and the state in which you live. Genworth provides an excellent summary of costs of all types of care for your state.
  • State guidelines define tasks and it is important to know what your selected agency can do or not do. Some states allow for tasks such as blood glucose monitoring and medications dispensing. Other states are very restrictive. They may allow only bathing, dressing, transportation, cooking and medication reminders.
  • There is no limit to the hours you can request for home care. Many people are able to afford 24-hour care or live-in help.

Although we know that people say they want to remain at home, this is not always possible – especially if the home health benefit has run out, and the cost of in-home personal care exceeds the cost of assisted living. Many people have the mistaken notion that insurance pays for assisted living. Unless you have a long-term care policy, assisted living is private pay. The only exception would be for people who qualify for Medicaid in some states.

What can you expect from assisted living and memory care?

  • Expect to pay anywhere from approximately $4,000 to over $9,000 a month.
  • A nurse is available, but not typically 24 hours a day.
  • All meals are provided.
  • Transportation to medical appointments is standard.
  • Weekly housekeeping and activities are included.
  • Medications are dispensed by the staff.
  • Memory care is often offered as an adjunct to assisted living. Memory care is for people with dementia or other cognitive disorders.
  • Most memory care communities are securely locked to prevent wandering.
  • All of the benefits o f assisted living are also offered in memory care.

What is the difference between skilled nursing and rehab?

Rehabilitation is a short-term in-patient option for people who have had a medical event or a decline in health. Stand alone rehabilitation facilities are common.

Senior man in physical therapy assisted by nurse
  • Rehabilitation is covered under Medicare. Coverage will differ depending on the type of Medicare plan you have.
  • The current rule is a three-night admission in a hospital. Recent Medicare changes are going to affect the amount of time that physical and occupational therapists can spend on a patient. If you care to get into the weeds on this subject, here is an explanation of how new Medicare changes may impact care both in rehab and home health.
  • Length of stay in rehab is determined by your progress and insurance plan. Most traditional Medicare plans will cover 100 days of rehabilitation if certain criteria are met.

Skilled nursing is a term used for long-term, 24-hour nursing when no other option is available. Skilled nursing is the most expensive of the care options listed above. Here are some of the circumstances that may necessitate long-term skilled nursing:

  • A qerson requires 24-hour supervision due to medical and/or cognitive needs.
  • A person is so medically compromised that they require 24-hour nursing and two people to assist with transfers.
  • Financial resources have become depleted. Aside from private pay, the only source of payment for nursing home is Medicaid. Medicaid has low-income criteria that must be met.

Alternative options for care

As the boomer age is upon us, creative and innovative options for care and housing are being developed. Many baby boomers are not interested in assisted living or can’t afford it. Others are looking for an alternative that will allow “aging in place” with the ability to transition to each level of care without having to move. The most popular of these is Continuing Retirement Care Communities (CCRC). Here’s how they work and things to consider befor deciding.

  • All care options are under one roof. From independent living all the way to skilled nursing. Transition from one level of care is relatively seamless.
  • Buyer beware. There can be significant up -front costs. Then add to that additional monthly fees. Entrance fees can range from $100,000 to a million depending on the community. For many people, selling their home is the only way to finance the entrance fee, and then you would need sufficient income to continue to finance the monthly fees.
  • Some communities have significant amenities including pools, restaurants, pickle ball courts and theaters.
  • Communities may have in-house home care options.
  • Since CCRC’s require significant land for development, some of the locations are not near urban centers.
  • Assess the financial stability of the company that has developed the CCRC that you are interested in.

We all want health, financial security and community as we age. Planning ahead for unexpected events that may affect health can give you the peace of mind. Knowing the costs and limitations of health care should be part of any retirement estate plan. Plan ahead and you will be glad you did!

Alliance America can help

Alliance America is an insurance and financial services company. Our financial planners and retirement income certified professionals can assist you in maximizing your retirement resources and help you to achieve your future goals. We have access to an array of products and services, all focused on helping you enjoy the retirement lifestyle you want and deserve. You can request a no-cost, no-obligation consultation by calling (833) 219-6884 today.

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