Long Term Care Newsletter April 2014
What Geriatric Care Managers Know…and Families are Shocked to Learn
Quick. Imagine a parent, co-worker, significant other, spouse or close friend receives terrible health news. They are diagnosed with a debilitating illness. Parkinson’s. Lou Gehrig’s. Alzheimer’s. There’s a long list of possible diseases.
Or, different, but just as shocking, you receive a call from the hospital waiting room. It’s an emergency. The person who yesterday was up and about is now in the ICU. Perhaps a stroke. An accident. Or is it a brain tumor? Again, no short list of possibilities.
Family and friends gather and the discussions begin. Where will the person live, both short-term, and in the weeks, months, and perhaps years to follow? Can any family or friends afford to put their work life largely on hold to be a caregiver? Not to mention the reality that underlies all the decisions: finances. How will all the bills – from mortgage and taxes to professional caregiving – be paid?
When it comes to buying professional long term caregiving, a hospital discharge planner is often the first person to explain that the kind of care the patient needs is not going to be covered by Medicare or health insurance. For example, if a nurse were needed to provide skilled care in the home, YES, Medicare or health insurance would pay the bill. However, if the care needed is custodial care for an Alzheimer’s patient who can’t safely live on her own, NO, Medicare or health insurance won’t pay the bill.
Post-hospital stay, it normally falls on the shoulders of a geriatric care manager (GCM) to help the family understand their options. GCMs are usually either on the payroll of care providers, or are independent consultants who work for (and are paid by) the family. Often, the first time that a family has considered how to pay for long term care is at time of crisis. What care options are available in the home or in a community setting? Is income high enough to easily cover these costs, or must assets be sold? What government programs exist that might help pay the bill, and what exactly are the qualification requirements? These are the kinds of questions GCMs can help answer.
An informal survey of GCMs asked them to reply to the question “What are families most surprised to learn when long term care is needed?” In addition to the information covered above, they answered:
Often state and local programs have low income requirements, and a limited number of spaces available each fiscal year. They are subject to the vagaries of politics – funding can be uncertain year-to-year.
Medicaid (Medi-Cal in California) planning can save some assets, but usually not all assets, from the cost of the nursing home. Almost all of an unmarried Medicaid resident’s income must be paid to the nursing home each month.
Medicaid is not “location-agnostic.” Another way of putting this is that Medicaid has an institutional bias. Those who rely on Medicaid to pay for their care are often shocked to learn that the home care or assisted living facility care they want is not covered by the program, while most expensive nursing home care is.
Long term care insurance is money earmarked by the insurance company to pay the insured’s long term care. Many LTCi policies include care coordination in their benefits, and some even cover the services of independent GCMs. Modern policies cover care in any setting, and the cost of a policy is pennies relative to the dollars of benefits.