Category: Long Term Care (Page 1 of 3)

When political values collide with Mom’s Need for Care: One Reader’s Crisis of Conscience.

March 10, 2025 / David Russell

"I find myself in a very conflicted position. I am 62 years old. I am a politically conservative person who has long believed that entitlement programs were a big part of this country's problems, and that Medicaid especially is responsible for creating a dependency on the government. Here's my situation: My 91 year old mother has depleted the savings that she and my dad worked to build, paying for care over the past five years. In five years, we have paid almost $400,000 between full-time sitters or nursing home care. Now she's out of money and the nursing home staff is telling me to apply for Medicaid for her. I could bring her home, but that would mean either me or my wife would have to quit our jobs or cut back on hours, and neither option is a good one. I can't afford to pay for her care out of my own pocket without severely impacting my own retirement, yet that's always been my belief - that families should take care of their own and not depend on the government. I'm in a real quandary as this goes directly against my beliefs, but I don't know what to do. I am an only child so there is no other family who can help."

Bill T.

First, you have my deepest respect for honestly confronting this clash of values that you have described. My personal opinion is that there may not be such a collision of values as you think. You seem to have taken personal responsibility for the care of your aging mother for the past five years, ensuring that the savings that your parents worked hard to accumulate have been used for her care in the best way possible. The fact that you feel conflicted about filing for Medicaid sounds less like a political view than a desire to continue that responsibility. You are certainly not alone as more aging parents from all political persuasions will likely need Medicaid’s assistance, and I want to gently challenge your belief that such programs only perpetuate government dependency.

Medicaid's Founding and Purpose

Medicaid was established in 1965 as part of the Social Security Act, with the purpose of providing health coverage to low-income individuals and families. Initially targeted at families receiving cash assistance, the program has since expanded to cover a broader population, including pregnant women, children, elderly adults, and individuals with disabilities. As of 2023, Medicaid covers over 83 million Americans, making it the largest source of health coverage in the United States. Medicaid is jointly funded by the federal and state governments, with total spending exceeding $600 billion annually. The program plays a crucial role in ensuring access to healthcare for millions of Americans who might otherwise be unable to afford it.

Criticisms of Medicaid

However, the cost and expansion of Medicaid have raised concerns among political conservatives. They argue that the rising expenditures place a significant burden on federal and state budgets, potentially diverting funds from other essential services. Additionally, some conservatives believe that the expansion of Medicaid encourages dependency on government assistance rather than promoting self-sufficiency.

Furthermore, well-documented cases of Medicaid fraud and abuse have contributed to a negative perception of Medicaid among many, but especially among more conservative Americans.

Reconsider Your Conflict

When people with conservative beliefs about personal responsibility face the need for help, such as caring for an aging parent without savings, they may encounter a conflict. Their value of financial independence clashes with the necessity to use government programs like Medicaid, which they previously saw as fostering dependency.

But is this really a moral and ideological dilemma that forces you to reconsider your beliefs in the light of your responsibilities and the stark financial realities you are confronting? The prevailing theme expressed by your beliefs seems to be taking responsibility, and you could consider that getting Medicaid support for your mother during what is likely the last remaining years of her life IS taking responsibility.

Applying for Medicaid does not negate the commitment to caring for your aging mother. Instead, it acknowledges the practical realities of the high costs associated with long-term care. By securing financial assistance, you are ensuring that your mother receives the best possible care, which is a responsible and loving act. Rather than creating dependency and irresponsibility in you, here are three things getting Medicaid for your mother would allow you to do.

Maintain Active Involvement: Even with Medicaid support, you can remain actively involved in your mother’s care. Regular visits, advocating for her needs, and staying informed about her health and well-being demonstrate your ongoing commitment and responsibility.
Focus on Quality of Life: By alleviating the financial burden through Medicaid, you can focus more on enhancing your mother’s quality of life. This might include spending more meaningful time with her, engaging in activities she enjoys, and ensuring she feels loved and supported.
Preserve Financial Stability: Seeking Medicaid assistance can help preserve your financial stability, allowing you to continue fulfilling other responsibilities and maintaining your independence. This approach ensures that you can care for your mother without compromising your own well-being and future.

So let yourself off the hook. You haven’t compromised your values, but perhaps you can see others in a more compassionate way. How many other Medicaid recipients value personal responsibility, but circumstances gave them few options but to accept the safety net that Medicaid offers? It’s ok to support Medicaid reform in order to make it more fiscally sound and free from fraud and abuse while also acknowledging its value to those who need it most.

Hollywood Cases Highlight the Benefits of Long Term Care Trusts.

March 4, 2025 / David Russell

When planning for long-term care, many individuals focus on purchasing insurance or setting aside assets to cover future expenses. However, financial abuse and mismanagement can derail even the best-laid plans. A long-term care trust offers a structured, protective approach to ensuring that funds are used appropriately, especially when an individual is no longer able to manage their own affairs.

What Is a Long-Term Care Trust?

A long-term care trust is a standby revocable trust designed to provide financial oversight for an individual’s long-term care needs. While the settlor (the person creating the trust) is capable, they retain control over the trust assets. However, the trust includes springing provisions—legal language that allows a successor trustee to step in and take over management if the settlor is deemed incapacitated.

The trust can own various assets, including long-term care insurance policies, life insurance policies with long-term care riders, and liquid assets designated for care-related expenses. Once the successor trustee takes over, they are responsible for filing insurance claims, paying expenses from the trust, and managing trust assets to ensure care needs are met.

Lessons from the John Amos and Mickey Rooney Cases

One of the most compelling reasons to consider a long-term care trust is to prevent financial exploitation, as tragically illustrated in the John Amos and Mickey Rooney cases.

John Amos, a well-known actor, who died in 2014, has been called a victim of elder financial abuse by his adult children, each claiming that the abuse was perpetrated by the other.

Mickey Rooney, another famous actor, provided powerful testimony before Congress about the financial abuse he endured in his later years. Rooney described how he was isolated, financially exploited, and left without access to his own money. His testimony shed light on the widespread issue of elder financial abuse and the devastating impact it can have on an individual’s dignity and well-being.

A long-term care trust may have helped prevent such abuse by placing financial oversight in the hands of a designated trustee rather than leaving assets vulnerable to manipulation by infighting siblings or self-serving outsiders. With a properly structured trust, all care-related expenses are managed transparently and according to predefined terms, reducing the risk of unauthorized withdrawals or misuse.

Key Benefits of a Long-Term Care Trust

Ensures Funds Are Used for Care Needs
By designating a trust to own long-term care policies and other assets, funds are explicitly earmarked for care expenses. This prevents potential misappropriation by well-meaning but financially strained family members.
Streamlines Insurance Claims and Payments
Managing long-term care insurance claims can be overwhelming, especially when a person is already facing health challenges. The trustee, as the legal owner of the policy, handles all paperwork, ensuring that claims are filed correctly and benefits are used as intended.
Protects Against Financial Exploitation
With a structured oversight system in place, there is a clear fiduciary duty to manage funds appropriately. The trustee must follow the trust’s terms, keeping records and providing transparency that minimizes opportunities for fraud or undue influence.
Reduces Family Conflicts and Burdens
Family members often struggle with decisions about paying for care, especially when different parties have competing financial interests. A long-term care trust provides clear guidelines, removing ambiguity and reducing potential disputes.
Offers Continuity and Professional Management
If a person becomes incapacitated, the transition of financial management is seamless. The springing provision allows for immediate oversight by the successor trustee, avoiding court intervention or delays that could disrupt care.

Selecting the Right Trustee: The Case for a Professional

Perhaps the most critical decision when establishing a long-term care trust is choosing the right trustee. While some individuals select a family member, this can create conflicts of interest, emotional strain, and potential mismanagement. Instead, using a professional trustee—either an institutional trustee (such as a bank trust department) or an independent professional trustee—offers significant advantages:

Objectivity – A professional trustee is neutral and bound by fiduciary duties, making decisions based on the trust’s terms rather than personal interests.
Expertise – Managing long-term care expenses requires financial, legal, and insurance knowledge that a professional trustee brings to the table.
Accountability – Unlike family members, professional trustees are legally required to keep records, report transactions, and manage funds prudently.
Reliability – Professionals are available long-term and will not face personal circumstances (such as illness or financial hardship) that might interfere with management duties.

A long-term care trust is a powerful tool for ensuring that assets are managed effectively, claims are handled properly, and financial abuse is prevented. By structuring the trust with springing provisions and selecting a professional trustee, individuals can safeguard their care needs and provide peace of mind for themselves and their families.

In a world where financial abuse and care mismanagement are real threats, a well-crafted long-term care trust offers a practical, protective, and proactive solution. Whether planning for yourself or helping a loved one, considering this option is a smart financial move that can make all the difference when it matters most.

When Our Care Plans Went Off-The-Rails

February 21, 2025 / David Russell

When my parents approached or passed 80 years, they lived more than 500 miles from my siblings and me. As they and their friends aged, the writing became clearly written on the wall of their minds. They needed to be closer to family. As they considered their options, the one that seemed to make the most sense was a highly rated CCRC facility only 15 minutes from us that would allow them to live independently in a detached home, with access to Assisted Living, Memory Care, and Skilled Nursing all within the same campus.

The Move Into a CCRC Facility

They paid a significant entry fee of approximately $290,000 in 2009 as well as a monthly fee of around $3,000 that guaranteed them continual care for the remainder of their lives. In addition, future costs were predictable. The fixed monthly fee would only increase slightly each year, but that was much less than the monthly rate they would pay if either of them entered any of the care units only when they needed it. Prepaying while they were independent also gave them priority status over those who lived outside the CCRC campus on room availability.

About four years later, dad’s dementia got worse, and he moved to the memory care unit just down the street from their house. Not long after that, he was moved to the skilled nursing facility where he died within a year. Mom continued to live in independent housing for the next 10 years and maintained an active social life.

The Impact of COVID on Facility Staffing

In 2020-2021 during the Covid-19 pandemic, nursing homes around the country were limiting or curtailing visitation of family members. At the same time, nursing homes and other care facilities around the country were experiencing severe shortages of workers, either lost by attrition during the pandemic, or those who were working dropped out of the workforce and either did not return or found work elsewhere. Little did we know how this would impact mom‘s care later.

Mom's Move to Skilled Nursing Care

In late 2023, at age 94, mom suffered a bad fall resulting in stroke–like cognitive impairment that required her to move into the skilled nursing facility of the CCRC. She was also a fall risk, so leaving her unattended for even the shortest period risks her getting out of the bed or her chair (which she has done on more than one occasion), thus far avoiding a severe injury. We were informed by the staff that they did not have enough workers to monitor mom close enough to prevent a fall, so we were encouraged to hire private, 24/7 sitters for mom, because even at night when she is sleeping, she will try getting out of bed on her own.

Our Financial Plans Went Off the Rails

Financially, we are blessed. Mom and Dad had enough resources to enter a facility that is not feasible for many. However, the long term plan did not consider that in addition to the CCRC’s cost, we would also need to add private sitter costs on top of the CCRC cost. We believed – rightly or wrongly – that the CCRC would be all they would ever need from the time of their move until they both died. Now, fifteen years after their initial move to the CCRC, they have paid over $1 million to the CCRC and are currently paying nearly $20,000 per month because of the additional care we are having to hire privately.

As the financial planner for my parents when all of this began, I am lamenting my unpreparedness for this contingency – not because it means less of an inheritance for my siblings and I (we’ve all been given more than we deserve) but because financial planning is largely about adding certainly to uncertain outcomes, and I believed that the CCRC option provided more certainty. We may have still chosen the CCRC for many other reasons, but it was a mistake to think that costs would be predictable. After forty years practicing financial planning, if there is one lesson on repeat in my own life, it is that nothing is certain, and financial plans are best made using a pencil with a very fat eraser.

Moral of the Story

The moral to this story is that long term care is expensive. It is unpredictable, uncertain, and will look different than what you plan for. If receiving care is in your future – meaning you don’t die on the way towards some level of dependency – over-insure for it, over-estimate the cost of it, plan for receiving it longer than you think, and if you do have the resources to self-insure for it, discuss your plans with your heirs or adult children before you need care. Otherwise, that bumper sticker you used to see on the back of an RV traveling down the highway, might best be saved for the door of your room at the care facility.

Mature woman (60s) helping elderly mother (90s) with paperwork.

Top Five New Year Resolutions for Financial Caregivers

January 14, 2025 / David Russell

As we enter a new year, many of us reflect on our goals and resolutions. For those who are stepping into the role of financial caregiver for an aging parent, the resolutions may take on a more personal and immediate significance. The transition into caregiving can be daunting, but with intentional planning and prioritization, you can provide meaningful support to your parent while also safeguarding your own well-being. Here are the top five priorities for financial caregivers to consider when making their New Year’s resolutions.

Daughter-in-law uses the “D Word” with Mom.

December 3, 2024 / David Russell

I am 81 years old and I live with my son and daughter-in-law. My husband died two years ago and my son insisted I move in with he and his wife. The problem is, my daughter-in-law thinks I have dementia, and uses hurtful comments like, 'well, that's just your dementia talking' or 'you must have Alzheimer's because you're so forgetful.' I hate being a burden on them, but I am most upset that my husband and I did not have a plan for this time in our life. I'd rather be living in my own home, but I don't see a way out. I feel trapped.

Margaret T.

I want you to know that your feelings of frustration and being trapped are valid, and it takes immense courage to share your thoughts. The transition into a new living arrangement at this stage in life, especially after the loss of your husband, can be incredibly challenging. You deserve to feel respected, valued, and autonomous even if you aren’t in your own home.

It’s important to recognize that both you and your daughter-in-law may be feeling overwhelmed. Caregiving can be exhausting, and sometimes stress can lead to comments that hurt more than help. Acknowledging that both sides may be struggling can create a foundation for better communication.

Open Communication is Key

I encourage you to have a heart-to-heart conversation with your son and daughter-in-law. Consider proposing a family meeting where everyone can express their feelings in a safe space. It may be beneficial to prepare what you want to say beforehand, so you feel more confident in expressing your thoughts clearly.

Express how hurtful comments about your cognitive state make you feel. You have the right to set boundaries around how you wish to be spoken to, and doing so can help foster a more respectful and supportive atmosphere at home.

Exploring Options for Independence

If living independently is something you desire, this could be a good time to explore options:

Discuss Alternative Living Arrangements: You could gently approach the idea of looking into independent living or assisted living facilities that might provide the support you need while allowing you to have your own space.
Maintain Your Social Life: It’s critical that you are able to maintain your social life. If there are friends that you connected with before, take measures to reconnect with them through activities, outings, or personal visits. If this isn’t possible, then using technology to connect with these friends in a personal way should be explored. This will help with feelings of isolation.
Consider Home Care Services: If it feels right, suggest the possibility of hiring a part-time caregiver. This could alleviate some of the burden on your son and daughter-in-law while allowing you to maintain privacy and independence.
Leverage Technology: If forgetfulness is concerning, devices that offer reminders for daily tasks can help manage that worry and allow you to maintain autonomy.

Dealing with Regrets

It’s clear that you are grappling with significant emotions, including regret about not having made plans for this phase of life with your husband. It’s common for many couples to focus on the present rather than anticipating future changes, which can sometimes lead to feelings of uncertainty and helplessness. Recognizing this regret is painful, but it can also offer a valuable lesson to others who may find themselves in similar situations.

The truth is that life can be unpredictable; having a plan, even a loose one, can provide a sense of security and options when challenges arise. As difficult as it is to navigate these circumstances now, your experience serves as an important reminder for others: it’s never too late to start planning for the future, regardless of age. Engaging in discussions about potential care needs, living arrangements, and preferences, even when everything seems fine, can pave the way for smoother transitions later.

Prioritizing Your Wellbeing

As you navigate these challenges, don’t forget to prioritize your mental health. Setting aside time for hobbies, reading, or simply relaxing can help you rediscover joy in daily life. If you feel comfortable, talking to a counselor or joining a support group for seniors can also provide a valuable outlet.

Consider keeping a gratitude journal to focus on the positives in your life, which can be empowering and uplifting as you work through this transition.

Moving Forward

Remember that though it may feel difficult, there are paths to reclaim your agency and independence. Your feelings matter, and advocating for your own needs is both important and appropriate. Life transitions can indeed be daunting, but with open communication and proactive steps, you can guide your situation toward greater respect and fulfillment.

I hope these suggestions resonate with you, and I wish you all the best as you move forward. You are not alone in this journey, and there is hope for a fulfilling future.

Politics isn’t the only subject to avoid at Thanksgiving!

November 25, 2024 / David Russell

My siblings and I will be gathering at our parents' home for Thanksgiving this year. It's the first time we've all been together in over five years. Our parents are in their early 80's and while they are independent now, my siblings and I have wondered whether they have a plan for advanced age or long term care. Since we are not all together often, would this be a good time to ask our parents what their plans are? My sister says yes, but my brother says it will only ruin Thanksgiving.

Belinda J.

Thanksgiving is meant to be a time of joy, gratitude, and family togetherness. But when important questions, such as aging and long-term care, linger in the background, it can pose a significant dilemma or create unwanted drama at the dinner table if broached without caution.

While the intent is certainly rooted in love and concern, many professionals suggest that Thanksgiving may not be the ideal time for such sensitive discussions. To best address your question, let’s look at several reasons why it may be better to postpone this important conversation and offer guidance on how to plan for a more appropriate time to delve into these discussions later.

Reasons Why Thanksgiving May Not Be the Ideal Time

Emotional Atmosphere: Thanksgiving can be an emotionally charged time for many families. The holiday brings together various sentiments—nostalgia, joy, and sometimes even stress—that may not create a conducive environment for serious discussions about aging. Introducing a heavy topic could unintentionally dampen the festive spirit.
Distractions and Busyness: During Thanksgiving, families often find themselves caught up in preparations, cooking, and entertaining. These distractions can make it hard to focus on a deep, meaningful conversation. An environment filled with noise and activity may prevent the thoughtful dialogue that these conversations require.
Fear of Conflict: Sensitive subjects about aging can sometimes lead to disagreements among family members. Introductions of differing opinions or concerns could escalate into tension, overshadowing the positive interactions that Thanksgiving aims for.
Lack of Preparation: Both parents and adult children might not be mentally or emotionally prepared to engage in discussions about long-term care during a holiday focused on gratitude and celebration. It’s essential to choose a time when everyone can reflect on the topic without distraction or stress.

Planning for an Intentional Conversation

Given these factors, it might be wise to plan for a more suitable discussion about long-term care and aging when the atmosphere is more relaxed and conducive to open dialogue. Here are some steps to help facilitate this:

Identify an Appropriate Time: Choose another family gathering—perhaps a holiday meal in the coming months or a family barbecue in the summer—as a priority for these crucial discussions. Setting a specific date allows family members to mentally prepare and ensures they’re ready to engage in constructive dialogue.
Create a Comforting Environment: Once you have a date in mind, plan the environment thoughtfully. A comfortable, quiet setting can enhance communication, allowing for open discussions where everyone feels heard and respected.
Build the Foundation Early: In the lead-up to your planned discussion, consider mentioning the importance of discussing aging and long-term care in a less formal setting. A casual conversation in passing can help normalize the subject. For example, during a family call or chat, you might say something like, “I’ve been reading a lot about aging and care planning; it’s something we should consider as a family.”
Engage Gently During Thanksgiving: Use the Thanksgiving gathering to plant the seed without forcing the conversation. You could bring up related topics, such as discussions about recent medical advancements or friends’ experiences in caring for aging parents. This can pave the way for future conversations without putting anyone on the spot.
Reassure Your Parents: If you know your parents have some thoughts about their future care plans, encouraging an ongoing dialogue can make them feel involved in the decision-making process. For instance, you can express appreciation for their independence and state, “I admire how well you both are managing, and I think it would be comforting for all of us to have a plan in place moving forward.”

Fostering Ongoing Conversations

Once you’ve planted the seed and the initial discussion takes place, continue to foster the conversation. This topic doesn’t need to be resolved in one sitting. Encourage check-ins that keep it open, ensuring that everyone feels comfortable discussing changes or updates in the future.

By creating a culture of transparent communication around aging, your family can approach the subject in a way that feels natural rather than forced.

Prioritize Connection Over Timing

While Thanksgiving offers a wonderful opportunity to bond as a family, it may not be the best moment to tackle serious discussions about aging and long-term care. By postponing this conversation to a more suitable setting, families can ensure that everyone is willing and able to engage thoughtfully. Planning intentional discussions and subtly introducing the topic can pave the way for a supportive dialogue, ensuring that family members feel connected and prepared for the future care of their loved ones. By prioritizing the right time and environment, families can foster an atmosphere of love and understanding while addressing the realities of aging head-on.

Dad has become “a Monster”

October 31, 2024 / David Russell

I know I'm supposed to keep a good attitude with my aging father. He moved in with us about six months ago after Mom died, but he has become a monster! He is demanding and expects me to wait on him hand and foot. He belittles me and is inconsiderate to my husband. He's even become suspicious of my handling his finances, which he is unable to do on his own due to his cognitive decline. I have two other siblings who live far away and they have no idea how difficult this is. I promised Mom I wouldn't put him in a nursing home, but this has become more difficult than I imagined.

Margaret A.

Ah, the joys of caregiving—where the role of dutiful child transforms into an unexpected stint as a live-in ghostbuster. Take a moment to appreciate the ghastly twist your life has taken since your father moved in after your mother’s passing. What started as an extension of your compassion and hospitality has somehow morphed into a full-blown horror show. Six months in, he’s become a monster! It sounds like you’re living in a haunted house, filled with demands that would make even the most patient caretaker break out in a cold sweat.

As the days turn into a series of eerie encounters, navigating your father’s new demands must feel like you are a character in an Edgar Allen Poe short story. From expecting to be waited on hand and foot to belittling comments, the challenges of caregiving can resemble a horror movie gone awry. It’s natural to feel frustrated and overwhelmed when the person you’re trying to support appears possessed by something other than common courtesy.

Reader asks, “What’s the difference between ‘assisted living’ and ‘nursing home care?

October 1, 2024 / David Russell

My father is 89 and seems to be forgetting things like taking his medications and practicing good hygiene. Last week, while visiting him at his home, it was clear he hadn't bathed for several days and he looked unkempt. I've been looking into nursing homes in the area where I live, but a friend suggested I look into an assisted living facility instead. What are the differences and is one generally more expensive than another?

Stan B.

It’s understandable to feel apprehensive when you notice changes in a loved one’s well-being, especially in their later years. Aging brings a myriad of challenges, and your attentiveness to these issues is commendable.

Your father’s situation—forgetting about medications and neglecting personal hygiene—is not uncommon among seniors. It can be difficult for them to maintain independence while also ensuring their needs are met adequately. Given these circumstances, exploring options like nursing homes and assisted living facilities is a wise move.

Dad has Alzheimer’s. Mom asked me to take over the finances. Where do I start?

September 17, 2024 / David Russell

I just found out my dad has been diagnosed with Alzheimer's disease. My mom called me and through tears asked if I would take over their financial affairs while she tends to Dad's care. I have no idea where to start, what they have, or where to find anything. I think they are fairly well off. They live comfortably and own a vacation property in Idaho that we all use occasionally. I have an older brother, so I'm not sure if I have the authority to do anything. She did say they have Wills in a safe deposit box, but I don't know how to access it. What should I do now?

Shelly T.

Receiving news about a loved one’s Alzheimer’s diagnosis is undoubtedly a heavy burden. It’s challenging to process the emotional ramifications, and on top of that, your mother is reaching out for help regarding their financial affairs. It’s natural to feel overwhelmed and unsure of where to start, but you’re not alone in this.

While this will be a profoundly personal journey, here are a few tips to begin the process of taking over financial decisions.

Reader is Confused: “Doesn’t Medicare Pay for Long-Term Care?”

August 27, 2024 / David Russell

I'm confused. My 78 year old dad recently had heart surgery and was released to a long term care facility for several weeks of rehab. He has Medicare and has a Medigap policy as well, but a long term care expert recently told me that Medicare won't pay for long term care. We've yet to get a bill from the facility, but now I'm concerned he's going to have to pay for this out of his pocket. Can you clarify this please?

Jeff P.

Sorting through health insurance details can sometimes feel like navigating a maze, especially when it comes to your dad’s recovery after heart surgery. If you’ve recently been told that Medicare won’t cover long-term care while he’s in a facility for rehabilitation, you’re certainly not alone in your confusion.

Medicare and Rehab Services

First off, let’s tackle the terminology. When we talk about long-term care, we often think of assistance provided in a nursing facility over an extended period. However, after a hospital stay, what your dad is receiving at that facility is actually classified as rehabilitation services – not long-term care —and that’s where Medicare comes into play.

To qualify for Medicare coverage in a skilled nursing facility (SNF), your dad needs to meet a few key requirements:

Hospital Stay: He must have a qualifying hospital stay of at least three consecutive days. Two days just won’t cut it, nor does admittance “for observation.” It must be an actual admittance for treatment in a hospital for at least three consecutive days!
Timely Admission: He needs to be admitted to a Medicare-certified skilled nursing facility within 30 days of being discharged from the hospital.
Type of Care: The services provided must primarily be skilled nursing care or rehabilitation therapy (think physical or occupational therapy).

Coverage Duration

Now that we’ve established that Medicare does indeed help with rehabilitation in a long-term care facility, let’s cover the specifics of what’s included:

Days 1-20: Medicare Part A kicks in and covers 100% of the costs in a Medicare-qualified rehab facility. It just so happens that many of these facilities are also nursing homes.
Days 21-100: From day 21 onward, there’s typically a daily copayment involved. For 2024, this amount is expected to be around $200 per day. Definitely something to factor into your budgeting.
Days 101 and Beyond: After the first 100 days, Medicare steps back and does not cover any costs. It’s all out-of-pocket!

Out-of-Pocket Costs and Medigap Magic

With the basics in mind, let’s get to the crucial part: out-of-pocket expenses. This is where your dad’s Medigap policy can really come to the rescue.

What is Medigap?
A Medigap policy is basically supplemental insurance that covers some of the costs that traditional Medicare doesn’t. Most Medigap plans help cover the daily copayment that starts after day 20.

Plan F: Offers full coverage of those copayments after the 20th day.
Plan G: Generally covers the copayments but requires that annual Part B deductible to be paid first.
Plan N: This one can require some copayments for certain services, but it still provides significant coverage for the days beyond 20.

Taking a closer look at your dad’s specific Medigap plan will give you the clarity needed to manage these potential costs.

Tips for Managing Long-Term Care Costs

Communicate with the Facility: When that first bill rolls in, don’t hesitate to reach out for clarification. Ask them questions about what Medicare is covering to understand your father’s financial responsibilities better.
Review the Medigap Policy: Make sure you’re familiar with the details of your dad’s Medigap plan. Each plan can have different coverage options, so understanding what’s included can help avoid surprises down the line.
Explore Other Aid: If costs start feeling overwhelming, consider looking into additional resources, like Medicaid or veterans’ benefits, which may help cover expenses once Medicare and Medigap benefits have been exhausted.
Get Professional Guidance: If you find yourself feeling lost in the financial fog, consulting with a financial advisor who specializes in elder care can provide direction and peace of mind.

While it’s easy to mix up the terminology surrounding Medicare, particularly when dealing with rehabilitation services in a long-term care facility, the key takeaway is this: If your dad is eligible and receiving rehab services, Medicare can help cover those costs—at least for a while! Understanding how Medicare and Medigap work together will empower you to make informed decisions about your father’s care and manage any potential financial burden.

Remember, you’re not alone as you navigate this. It may feel complicated now, but with a bit of persistence and the right information, you’ll find your way through!

Feel Alone as a Financial Caregiver?

Join a community of other learners just like you!

Learn More