How Medicare and Medicaid Are Addressing Long-Term Care Issues

Deciding how to receive the medical care that a person needs is a critical part of the elder law process. Unfortunately, the unpredictable nature of aging and medical issues can make it challenging to determine what lies ahead. Various states have also begun to attempt to resolve financing challenges associated with elder care that a growing number of Americans will face in the next couple of decades as a growing portion of the baby boomer generation requires medical care.

The Growing Need for Assistance

Any person can end up needing assistance as they age. This is true regardless of whether a person ends up facing dementia, a significant drop in eyesight, or mobility issues. The degree of assistance and how long a person faces these issues can vary substantially. A person might end up needing assistance with meals, other daily living activities, or total care for the months or years before they pass away. Other times, people end up needing total care for years. The unpredictable nature of a person’s future makes it challenging to plan ahead.

The challenge associated with planning for care is made further difficult by the country’s disjointed healthcare system utilized to provide care and pay for it. For many families faced with long-term care challenges, they’re often left to piece together several options when an elderly loved one becomes ill, faces mobility issues, or is diagnosed with dementia.

Creating a Personalized Care Strategy

Without a universal long-term care option made available by either the state or federal government, countless for-profit and nonprofit organizations have been established to provide services like home care, assisted living, and nursing home assistance. Families must determine the best fit and what’s best for a loved one can change over time as the person’s needs and conditions as well as while the available resources are spent. 

The Importance of Medicare

Few retired people have adequate resources to pay for their care for an extended duration of time out of pocket. One study from Boston College’s Retirement Research Center found that over half of today’s 65-year-olds require medium to high level of care for over a year. Approximately two-thirds of this care will ultimately be provided by a family member for no cost, while a third of the care will be provided by caregivers who receive payment. Care can be as low as $1,000 a month to retain caregivers to be used in tandem with assistance provided by family members or as much as $20,000 monthly for nursing homes or 24/7 home care services.

Medicare plays a sizable role in paying for costs, but Medicare only covers “skilled” needs after a person has been hospitalized. Medicare pays for a maximum of 100 days of care in a skilled nursing facility after a hospitalization, but the coverage for home health services is never comprehensive.

Older adults routinely rely on their own funds until they run out of resources and qualify for Medicaid coverage. Medicaid coverage is nuanced, but generally, a person is required to spend down to only $2,000 in savings and investments while married couples must spend down to $132,380 and ownership of their home.

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