Information About Continuing Care Communities

Life plan communities, often referred to as continuing care retirement communities (CCRCs), are an increasingly popular choice of aging Americans. These communities offer the array of care options necessary as seniors move through the stages of aging that include independent or assisted living, memory care, and skilled nursing. Beyond health care CCRCs offer a wide range of services “such as housekeeping, dining options, transportation, fitness and wellness programs, recreational activities as well as social activities and outings for residents.” It is essentially “aging in place” except in a community environment. There are approximately 2,000 CCRCs in the country as compared to about 30,000 assisted living facilities primarily because the price of a CCRC is about $3,000 to $5,000 a month. If you can and are considering joining a CCRC, there are some parameters to consider very carefully.

The first consideration is financing. Can you afford the buy-in and associated monthly fees? If necessary, a senior is allowed to convert home equity and other assets into their initial expenditure to join a CCRC however, the vast majority of seniors who choose to reside in a CCRC have the personal financial resources to fund the stay out-of-pocket. All facilities and contracts are different. Each state has an agency that regulates CCRCs, and the government entities offer listings and a consumer guide about the CCRCs available in your state. There is also an independent nonprofit organization called CARF International, which provides accreditations for CCRCs and their services.

Overall, you will not be able to use Medicare to cover the cost of a CCRC because Medicare Services do not cover long-term care. The exception for Medicare coverage is if you use skilled nursing services while in your CCRC facility; Medicare will cover up to 100 days of that service. Because these CCRC contracts are similar to a “long-term insurance plan” it is tax-deductible because the IRS considers it a prepaid medical expense. The financial picture is different for every individual and every facility so get with your financial planner and elder law attorney to carefully review the contract and its terms before committing to anything.

While every CCRC is different, there is some standardization in the three types of contracts that are typically offered. The first is an all-inclusive, fixed price contract. While it is the most expensive contract, it provides unlimited access to all of the assisted living, medical care or skilled nursing care at no additional charge. This contract is best for someone entering the facility while still healthy and independently able. The second option is a modified contract that provides services for a set length of time which is a gamble. In the event you outlive the contractual timeline the additional services required are likely to expose you to a higher monthly fee. The third type of contract is a fee for service which means you only pay for the services you use. Fee for service contracts typically lowers your entry cost into the community, but you will pay market rate for assisted living or skilled nursing care if you need those services.

The best time to make a move into a CCRC is when you are healthy and able to take advantage of all the facilities have to offer. Being in a community that provides health and wellness strategies above and beyond medical care can allow you to age more successfully and with fewer health incidents. Moving into a CCRC is not a decision to be made in desperation because of an urgent health care need. The complexity and range of the CCRC contracts and pricing options need your careful thought and review with professional guidance to optimize your aging experience. Seniors with a spouse find a CCRC living choice particularly gratifying because partners will need different medical help at different rates. Even if the couple is not living in the same unit due to medical conditions they are at least on the same campus.

The social and activity amenities offered in CCRCs are very interactive and keep residents engaged. However, if the location of the campus is remote from urban environments, you might feel isolated and disconnected from the world at large. Some CCRCs are popping up in downtown locations and even on college campuses around the country. So be certain when considering a move to a CCRC you ask yourself if the site appeals to you for the long term. Also, find out how far removed it might be from family members you want to visit with often.

There are many questions to ask when contemplating a move into a continuing care retirement community. Visit the property and bring a family member or legal counsel to ensure the proper inquiries are made and that answers are complete. Ask to spend a week at the facility to experience it first hand and avoid buyer’s remorse. You are deciding whether to reside at a property for the rest of your life and must be sure that the facility is a fit for you. Because there have been bankruptcies in the CCRC business sector, you must review the facility’s financial sustainability. You do not want an unsuccessful CCRC to force you into a relocation process late in life that can be financially, physically, and emotionally draining.

Recognizing and Reporting Elder Abuse

What is Elder Abuse?
Elder abuse is a problem that takes many forms. Unfortunately, many seniors are subjected to elder abuse and often times the abuse goes unreported and the abuser goes unpunished. Elder abuse may take the form of physical abuse, include hitting, striking, beating, kicking, and using excessive force. This may also include the overuse of restraints or drugs.

Emotional or psychological abuse is also a common form of elder abuse. This can be anything that causes emotional pain or distress and may include verbal assaults, intimidation, isolation, humiliation, and harassment.

Neglect is also a common form of abuse in senior citizens. Neglect is when a caregiver fails to provide the necessary care for the senior citizen under their care. In contrast, self-neglect is when a senior citizen who is mentally competent refuses to care for their own needs and causes harm to themselves.

Financial exploitation is yet another form of elder abuse. Financial exploitation is often committed by family members (most common), caregivers, or strangers.

Reporting Suspected Abuse
Adult Protective Services (APS) is often the first to receive reports of or to respond to reports of elder abuse. Their job is to provide for the safety, health, and well-being of elderly and vulnerable adults. The law requires those who work with senior citizens in various capacities to report to APS if they suspect elder abuse. When APS receives reports of abuse or neglect, they have several possible actions or interventions. They are responsible for receiving and investigating reports of elder abuse. They then must evaluate the victim’s risks and assess the victim’s ability to understand their risk and give informed consent. The APS worker can then develop a case plan for the abused elder. Once a case plan has been decided, the case worker can arrange for necessary care, medical attention, and legal consultation. Once this is done Adult Protective Services then monitors the services and evaluates the case.

More serious cases of abuse may be reported directly to police. If a senior is in immediate danger, this may be the best course of action.

Many websites provide information on warning signs of potential physical abuse, emotional/psychological abuse, sexual abuse, neglect, and financial abuse. If you have a loved one who is a senior citizen, it is important to know the warning signs for abuse. It is also key to stay involved with the caregivers and to make regular visits to check on the care of your senior loved one. The National Adult Protective Services Association, http://www.napsa-now.org/get-informed/ , has important information on different types of abuse, as well as ways to get help in any state

What is Long Term Care Insurance?

Long-term care insurance is very beneficial for the elderly or disabled person who need will services or support to meet their personal care or health needs. However, it is important to understand long-term care insurance before the time comes when the benefits are needed. Unfortunately, many people wait and then miss out on what long-term care insurance can offer.

Should I get long-term care insurance?
There are a few things to consider before you go out and purchase long-term care insurance. First, consider your age. Age is important because it is much cheaper to get long-term care insurance at a younger age. Older adults and those who already have existing health conditions may have more difficulty getting long-term care insurance and the premiums are guaranteed to be costly.

Second, consider your support system. In other words, do you have family who will be able to help provide for your care needs in the future? If so, then you may not need long-term care insurance. This is definitely a good time to sit down and talk about the future with your family.

Third, consider your savings and investments. This is where a financial adviser or elder law attorney can help you understand ways to pay for long-term care and whether or not long-term care insurance is right for you.

What is the cost of long-term care insurance?
The cost of long-term care insurance cannot be attached to specific numbers. The cost depends on age, gender, marital status, the insurance company, and the amount of coverage. The younger a person is when they get long-term care insurance, the lower the premiums will be. Generally speaking, long-term care insurance policies are less expensive for men than women. This is due to the fact that women generally live longer and therefore are more likely to make claims on the long-term care policies. Married people have lower premiums than single people. Just like with any type of insurance, rates for long-term care insurance will vary from one company to the next. It is important to shop around and compare the costs of long-term care insurance with a variety of carriers. The amount of coverage desired greatly affects the cost of the long-term care insurance. Better coverage with fewer restrictions will come at higher premiums. Be sure to do your homework, talk to your financial planner, and elder law attorney to help determine long-term care insurance needs.

What does long-term care insurance cover?
Once you have a long-term care policy, you are eligible for benefits if you have dementia or another cognitive impairment or you are unable to perform at least two of six activities of daily living. These activities include bathing, dressing, eating, toileting, caring for incontinence, and transferring. When a policyholder is eligible and in need of filing a claim on a long-term care insurance, a variety of services may be covered. Nursing homes and assisted living facilities may be covered services. Within those services, policies may only cover room and board or they may cover more extensive services. Long-term care insurance also covers adult day care services for those who need a program for health, social, and other support services during the day. Home care is also provided under some long-term care insurance. This service helps with activities of daily living in the policyholder’s home. When home adaptations are necessary, such as ramps or grab bars, long-term care insurance can cover these services. Care coordination and future service options are also available services with within long-term care insurance policies. You will need to understand your specific policy to determine the specifics of the services covered and to what extent they are covered.

Long-term care insurance can seem very complicated. Remember there are professionals who specialize in helping to determine long-term care insurance needs and coverages. A great place to start is with your financial advisor and elder law attorney.

If you have any questions about something you have read or would like additional information, please feel free to contact us.

Helpful Ways to Pay for Assisted Living Costs

Assisted living rent can vary from $2,000 to $5,000 monthly. Depending on what type of care your loved one needs, assisted living can be the most affordable solution when compared to a nursing home ($5,000 to $10,000 or more per month) or long-term in-home care. If closely monitored medical supervision is not necessary for your aging senior, assisted living might be the best financial choice.

One payment strategy that has become popular is to use Medicaid. If your loved one does not have many financial assets and their income levels are low, this could be the right solution for them. Medicaid varies from state to state both in name and in eligibility requirements. Many states dictate that a senior is eligible if he or she has less than $2,000 in assets, or $3,000 if married.

If you are trying to help a senior with a creative financial strategy by gifting money and other assets to family members, known as “Medicaid spend-down”, the government has a five-year look-back rule regarding financial transactions. There are strict guidelines about Medicaid spend-down. If a senior is caught incorrectly spending down resources to qualify for Medicaid, the penalties are steep, including disqualification from receiving Medicaid for a lengthy period. Also, many states do not cover assisted living under Medicaid, but require the submission of an additional wavier. Be aware that Medicaid assisted living payments are only accepted by some communities and Medicaid beds are usually limited. There can be long waiting lists to enter into a Medicaid financed assisted living facility.

If your senior has a disability, he or she may qualify for Supplemental Security Income (SSI), which is a federally administered program. SSI is the government safety net for those destitute and wholly or partially disabled by illness or injury. SSI is a monthly payment which a senior can use to pay for assisted living. To qualify for SSI, contact the appropriate local Social Security office and provide financial documentation and a doctor certification to attest to your senior’s inability to work because of a medical disability.

If your loved one or their spouse is a Veteran, residential care could be paid for in a variety of situations with Veterans benefits. There is a set of benefits available to those with disabilities or service-related injuries, and there is also another set of benefits called Aid and Attendance, made available to any Veteran or surviving spouse who is both disabled and whose income is below a certain threshold. The Veterans Administration website outlines the complicated process to access benefits. It is extremely beneficial to work with an elder law attorney who knows the details of the programs and can assist with the application.

A life insurance policy can pay for your loved one’s assisted living. Often, seniors have a long-standing policy that was implemented to help family members upon their death, but a life insurance policy can provide financial support now. A process known as “accelerated” or “living” benefits is a “cash out” policy that can have your senior redeem 50 to 75 percent of the face value of the policy. Each amount is based on specific policy conditions as well as individual corporate rules. Some policies can only be cashed out if the policyholder is terminally ill while other companies are more flexible in cash outs. If your senior’s particular company does not allow the policy to be cashed, it can still be sold to a third-party company who usually affords the same 50 to 75 percent face value cash out. That company continues to pay the original premiums until their death, at which time the company redeems the full value of the policy. Finally, if your loved one’s policy is of lesser value, it may qualify for a life settlement option known as a “life assurance” benefit or conversion program, which allows the senior to convert between 15 and 50 percent of the policy value directly into long-term care payments.

Does your loved one have a long-term care insurance policy? It can pay for assisted living care. Policies vary, but once the determination and action is taken to collect on it, those monies can be paid directly to an assisted living facility or to the beneficiary who in turn pays the facility. It is wise to consult with an elder law attorney to help understand individual company requirements to optimize the process of collection.

An annuity can be used to pay for some or all of the senior’s assisted living. If your loved one invests a lump sum into an annuity, they will receive regular payments over a promised time period, usually the rest of their life. The annuity helps to stretch your senior’s budget and guarantee at least some money is coming in, even in the event they live longer than expected. Most annuities allow the beneficiary to continue to receive money regularly even if the purchase premium runs out. If your senior were to live a very long time, they would get more back than they put in and an added bonus is that annuities are oftentimes not fully counted as assets by Medicaid when applying for government assistance. The income is counted but not the value of the asset. It is imperative to seek the advice of an elder law attorney before opting into an annuity as they are complex financial products and a wrong decision could be disastrous.

Reverse mortgages are another strategy to pay for assisted living. If your loved one owns their home outright or has only a small mortgage on it, they can get cash value from their home equity in a lump sum or series of monthly payments. The bank will decide the valuation of the home based on multiple factors like the homes worth, interest rates and the applicant’s age. The borrower can stay in the house until death even if the loan balance exceeds the worth of the home. After death, the loan balance has to be repaid which usually means selling the home. Reverse mortgages were developed to help widows remain in their homes after the primary income earner passed away or if that spouse needed to move into assisted living, leaving the other spouse to reside in the long-time family home. Like annuities, a reverse mortgage is a complex financial product, and it is crucial to receive sound advice from a trusted professional and work with a reputable reverse mortgage company. If only one senior parent is living and they do not want a reverse mortgage, they might consider renting out their home and using a landlord to manage the property. The income from renting the house can be used to pay for assisted living expenses.

Lastly, it is possible to pay for assisted living with a bridge loan, which is a short-term loan of up to $50,000 explicitly designed to provide funds to move a loved one into an assisted living facility or continuing care retirement community. It is an unsecured (no collateral required) line of credit with the intent to finance the first few months of living expenses during the sale of the senior’s home, while the application for Veterans benefits is pending, or other actions that are taken that free up funds. Since the interest rates can range from 8.25 to 12.5 percent, this option is best as a short-term strategy. The other type of bridge loan is called the Capital Access Program. It is a lower interest lump sum loan secured by real estate or other assets that the company deems acceptable collateral. It is designed to help seniors come up with the large upfront entrance fee some senior assisted living facilities require. Both types of loans are based on the usual credit criteria: credit score, credit history, debt to income ratio, and more. The senior or an adult child can secure the loan, and up to six family members can cosign loan applications, allowing the risk to be shared among multiple family members.

If your loved one is healthy enough to successfully live in an assisted living facility, the monthly cost is likely a top factor when considering their options. These are some, but not all of the viable and creative ways to pay these costs. To fully explore the options available and what is best for your senior seek the advice of an experienced elder law attorney and make the best decision for your loved one. Contact our office today and schedule an appointment to discuss how we can help you with your planning and which strategy is best to help your senior pay for assisted living.

The rise of bankruptcy in the lives of aging Americans

The golden years are turning into bankruptcy red for many retired and aging Americans. While medical advances are keeping seniors alive longer, the associated healthcare costs in the quest for longevity are being off-loaded onto the older individual at a time when reduced income is a hallmark of senior living. Older Americans are increasingly filing for consumer bankruptcy. According to the Consumer Bankruptcy Project, the population aged 65 or more are filing for bankruptcy at a two-fold increase, and there is nearly a five-fold increase in the percentage of seniors in the US bankruptcy system. The economic risk for seniors is running rampant, and the sad truth is currently 97 out of 100 people aged 65 and over are not able to write a check for $600 or more due to insufficient funds.
The sentiment among Americans is that their standard of living will increase at the age of retirement when it is quite the opposite. The typical retiree has set aside about $60,000 for their old age living, and more than 50% over the age of 55 have saved less them $50,000; as much as 40% of these workers have less than $25,000 set aside. The stark reality is none of these “nest eggs” are enough to see a senior through old age and the unforeseen disasters that can deplete what little has been saved.
One of the more common financial obstacles that create this bankruptcy scenario is a health issue. Medicare is not comprehensive. In the absence of a supplemental insurance plan picking up the non-Medicare funded 20 percent cost, a senior can be left with unforeseen operation and rehabilitation costs. Without full health care coverage, the cost of staying alive as a senior is practically prohibitive between prescriptions, treatments, surgeries, rehabilitation, and assisted care. The primary two options available to a senior to cover these costs of survival are credit card debt and loans. Suddenly, at a time when most seniors should have very low monthly living costs, they find themselves back in a debt slave scenario with little or no income to address their healthcare debt.
Many seniors have concluded that retirement is not a part of their future as they will need a viable stream of income to avoid financial disaster. While this seems reasonable, it is not a good plan to assume one will be healthy enough to work forever. As we age, there is an increased probability that working will become impossible due to unforeseen illness. When this happens, debts begin to mount, and bankruptcy becomes a likely result. Additionally, the era of stable pensions afforded to a long time employee has gone by the wayside. Fewer companies even offer them anymore and those that do often modify and reduce pension benefits to meet corporate expectations of financial profits.
The cost of living rarely if ever is reduced over time and while social security benefits seem like the answer to a senior’s retirement years; these benefits seldom cover basic living expenses no matter how long an individual may have worked or how much they paid into the system. The senior who is faced with government social security benefits and very little additional income usually turn to credit cards to address the gap between low income and living expenses. This scenario takes a senior right back to debt slave mode. As many as two out of three seniors who file for bankruptcy cite credit card debt as one of the primary reasons.
Scams that target the senior population are becoming more sophisticated and prolific with the advent of technology. What used to be a “one to one” scam can now be distributed via email to thousands of targeted seniors who are online in greater numbers than ever before. Often the unsuspecting senior will make passwords or personal bank information available to what they believe is a legitimate request for information from what appears to be a valid email. Seniors can also fall prey to predatory lenders as many seniors cannot read the fine print or understand the consequences of their actions. When scam artists victimize a senior, the senior often loses a large chunk of their assets which in turn can put them in a bankruptcy scenario.
While it is impossible to know the exact future, it is possible to make reasonable plans for it. Learn the ways that you can protect yourself from becoming part of these bankruptcy statistics in your senior years. Even a modest plan is better than no plan at all. Seek the advice of trusted legal and financial professionals to help you understand what you can do to protect your future. Please feel free to contact our office today to discuss how we can help you with your planning.
If you have any questions about creating a secure financial future for retirement years, call us today! Tel: 623-252-0292