I am reposting this from a Note I wrote in Facebook because I thought it was worth having it here as well.
I haven't written a note in a loooong time, but considering the experience I am having with my dad, I thought this information might be useful to some people. I think I am a decently informed human being, but I had all sorts of wrong ideas about this stuff. I am kicking myself for not researching it earlier.
I have been operating under the assumption that when/if my dad needs help with things like toileting and bathing, it would be covered under the home care part of his insurance. Nope. And I think that is pretty much standard because things like that are covered in long term health care insurance policies. The only type of home care that is covered is when there are things needed that only a nurse can do.
I also had some sort of assumption that the board and care type of facilities, which require a higher level of care, were covered under the nursing home portion of my dad's insurance. Wrong again. If the person does not need actual medical procedures, which a nurse or doctor would need to perform, not covered. That is why the distinction of Skilled Nursing Facility is so important.
My dad's insurance, which he kept telling me has a lifetime cap and then he pays nothing, actually has significant limits. Yes, there is a lifetime dollar max, but there is also a lifetime limit of 365 days in a SNF. Even if my goal is to keep him home, elderly people often spend time in a SNF after surgery for rehab, and there might come a time when his needs exceed what can be handled at home. And in home nursing care has an even lower limit, like 120 days per lifetime iirc. Will he exceed the number of days? No way to know. Nobody has a crystal ball. But if he does, SNFs can run close to 20k/per month! They are not always that much, but I think around 7k is the lowest around here - still way more than he gets per month. The money my dad has in savings, which he thinks is a fortune, won't even last him half a year!
Now I understand why I hear story after story about people spending their parents whole life savings on their end of life care. I know my parents would not want that, but they didn't really foresee any chance of having a long lasting illness that might need nursing help for more than a year I guess. I don't think they really understood dementia as an *illness* either. Cancer took my mom before her dementia got bad. And it is way past too late to get that type of insurance. The cutoff is usually around 75, IF you even qualify. Some conditions get you an automatic denial.
So what is the moral of this story? If you think you might have any assets you hope to pass on to your children, BUY LONG TERM CARE INSURANCE. You can get it for just SNF care or to have somebody come to your home to help you with daily life activities, when you are in a place similar to my dad, or for both. If you don't care if you spend all your assets and end up using Medicaid, it doesn't really matter. But don't gift any money to your kids near the end of your life (or find a lawyer to help you - more on this below in comments). That issue is one I am facing right now. My dad wants to give a good portion of his money to us (and by want I mean he is actually *agitated* by how much money he has in the bank and even *cries* about wanting to give it away), but if he needs Medicaid (Medi-Cal in CA), his benefits will get put on hold if he has been giving money away. And in some situations, a SNF can even sue you if you took money from your parent! Also, putting a home in a trust does not make it exempt. You can keep your home if the other spouse is living in it or you can transfer it to a child if they are disabled, a minor, or have been caring for you in it for 2 years to keep you out of a SNF, at least in CA. Otherwise, expect to sell the home to pay for care. (There may be other exceptions - I am not a lawyer - but those are the only ones I have turned up.)
Oh and even if you don't think you will have assets to pass on, if there ever comes a time you want some daily assistance, but you aren't sick enough to be in a SNF, expect to pay around $20/hr if not more by then, and there are usually hourly minimums. Looking into it for my dad, if I were to hire somebody to come twice a day to make sure he takes his meds, it comes to more than he gets per month, even with his pension.
So yeah... many lessons learned. Things I wish I had known 10 years ago. Possibilities I wish I had considered. I hope this helps somebody look ahead in ways that will help them in the future.
EDITING TO ADD these comments about from a friend: As a RN Case Manager, my heart breaks everyday as I assist families as they navigate the confusing waters of moving their loved ones from the hospital to a skilled nursing facility. The worst part is telling families that the patient has not had a Medicare qualifying ( 3 midnights in an acute care hospital and meeting medical necessity criteria) and watching their hearts break when they realize they will have to pay privately and exhaust their resources. It's just awful. I would encourage everyone to look into long term care policies, but buyer beware!! Some are worthless and have lots of exclusions and clauses. One I reviewed recently had a clause that the insured has to self pay for 6 months at a facility before the policy would kick in. Mind you the gentleman had been paying over $600 a month for that coverage. He can't get out of the contract ... Kind of like a timeshare nightmare. Also, Medicaid is getting tougher. It used to be a 2 year look back in Wa state, now it's a five year look back... They are looking to see if assets were gifted or transferred within that time frame. I strongly encourage as our parents age, visit with a highly skilled elder law attorney and begin estate planning.
And I will add to this... if your parents tell you they have done estate planning, don't assume they did a good job. :/
I haven't written a note in a loooong time, but considering the experience I am having with my dad, I thought this information might be useful to some people. I think I am a decently informed human being, but I had all sorts of wrong ideas about this stuff. I am kicking myself for not researching it earlier.
I have been operating under the assumption that when/if my dad needs help with things like toileting and bathing, it would be covered under the home care part of his insurance. Nope. And I think that is pretty much standard because things like that are covered in long term health care insurance policies. The only type of home care that is covered is when there are things needed that only a nurse can do.
I also had some sort of assumption that the board and care type of facilities, which require a higher level of care, were covered under the nursing home portion of my dad's insurance. Wrong again. If the person does not need actual medical procedures, which a nurse or doctor would need to perform, not covered. That is why the distinction of Skilled Nursing Facility is so important.
My dad's insurance, which he kept telling me has a lifetime cap and then he pays nothing, actually has significant limits. Yes, there is a lifetime dollar max, but there is also a lifetime limit of 365 days in a SNF. Even if my goal is to keep him home, elderly people often spend time in a SNF after surgery for rehab, and there might come a time when his needs exceed what can be handled at home. And in home nursing care has an even lower limit, like 120 days per lifetime iirc. Will he exceed the number of days? No way to know. Nobody has a crystal ball. But if he does, SNFs can run close to 20k/per month! They are not always that much, but I think around 7k is the lowest around here - still way more than he gets per month. The money my dad has in savings, which he thinks is a fortune, won't even last him half a year!
Now I understand why I hear story after story about people spending their parents whole life savings on their end of life care. I know my parents would not want that, but they didn't really foresee any chance of having a long lasting illness that might need nursing help for more than a year I guess. I don't think they really understood dementia as an *illness* either. Cancer took my mom before her dementia got bad. And it is way past too late to get that type of insurance. The cutoff is usually around 75, IF you even qualify. Some conditions get you an automatic denial.
So what is the moral of this story? If you think you might have any assets you hope to pass on to your children, BUY LONG TERM CARE INSURANCE. You can get it for just SNF care or to have somebody come to your home to help you with daily life activities, when you are in a place similar to my dad, or for both. If you don't care if you spend all your assets and end up using Medicaid, it doesn't really matter. But don't gift any money to your kids near the end of your life (or find a lawyer to help you - more on this below in comments). That issue is one I am facing right now. My dad wants to give a good portion of his money to us (and by want I mean he is actually *agitated* by how much money he has in the bank and even *cries* about wanting to give it away), but if he needs Medicaid (Medi-Cal in CA), his benefits will get put on hold if he has been giving money away. And in some situations, a SNF can even sue you if you took money from your parent! Also, putting a home in a trust does not make it exempt. You can keep your home if the other spouse is living in it or you can transfer it to a child if they are disabled, a minor, or have been caring for you in it for 2 years to keep you out of a SNF, at least in CA. Otherwise, expect to sell the home to pay for care. (There may be other exceptions - I am not a lawyer - but those are the only ones I have turned up.)
Oh and even if you don't think you will have assets to pass on, if there ever comes a time you want some daily assistance, but you aren't sick enough to be in a SNF, expect to pay around $20/hr if not more by then, and there are usually hourly minimums. Looking into it for my dad, if I were to hire somebody to come twice a day to make sure he takes his meds, it comes to more than he gets per month, even with his pension.
So yeah... many lessons learned. Things I wish I had known 10 years ago. Possibilities I wish I had considered. I hope this helps somebody look ahead in ways that will help them in the future.
EDITING TO ADD these comments about from a friend: As a RN Case Manager, my heart breaks everyday as I assist families as they navigate the confusing waters of moving their loved ones from the hospital to a skilled nursing facility. The worst part is telling families that the patient has not had a Medicare qualifying ( 3 midnights in an acute care hospital and meeting medical necessity criteria) and watching their hearts break when they realize they will have to pay privately and exhaust their resources. It's just awful. I would encourage everyone to look into long term care policies, but buyer beware!! Some are worthless and have lots of exclusions and clauses. One I reviewed recently had a clause that the insured has to self pay for 6 months at a facility before the policy would kick in. Mind you the gentleman had been paying over $600 a month for that coverage. He can't get out of the contract ... Kind of like a timeshare nightmare. Also, Medicaid is getting tougher. It used to be a 2 year look back in Wa state, now it's a five year look back... They are looking to see if assets were gifted or transferred within that time frame. I strongly encourage as our parents age, visit with a highly skilled elder law attorney and begin estate planning.
And I will add to this... if your parents tell you they have done estate planning, don't assume they did a good job. :/
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