What is Long Term Care and Eldercare? ...... 5 Understanding the Need and Settings for Long Term Care. 6 Temporary Long Term Care...... 6 Ongoing Long Term Care ...... 6 Custodial Care versus Skilled Care ...... 7 Formal Care versus Informal Care...... 8 Formal Caregivers...... 8 Informal Caregivers...... 8 Understanding the Progression of Care Commitment ...... 9

Making a Plan for Your Long Term Care ...... 11 Reasons to make your plan now...... 12 Finding Help for Current Caregiving Needs ...... 12

Understanding Care Settings ...... 13 Retirement Communities ...... 14 Master Planned Active Adult Communities...... 14 Planned Communities with No Age Restrictions...... 15 Condominiums...... 15 Manufactured Housing Communities...... 15 Seniors Apartments ...... 16 Independent Living Facilities and Congregate Housing..... 16 Assisted Living Facilities...... 17 Continuing Care Retirement Communities ...... 20 Combined Care Communities...... 20 Nursing Homes ...... 22 How Do You Select a Nursing Home?...... 22 Costs for Nursing Home Care...... 24 Medicare Nursing Home Coverage...... 24 Medicaid...... 25 Insurance ...... 26 Home Care...... 26 Living In Your Home with Care Provided by Others.. 26 I Informal Caregivers ...... 27 Formal Caregivers ...... 27 Cost of Home Care...... 28 Adult Day Services ...... 30 Housing for the Elderly Poor...... 31 Hospice Care...... 32

Community & Government Long Term Care Programs...... 33 About Government Long Term Care Programs...... 33 Community Groups and Services...... 33 Senior Corps...... 34 Senior Centers...... 34 Administration on Aging...... 34 Eldercare Locator ...... 35 Food Stamps ...... 35 Housing Assistance ...... 36 Low Income Energy Assistance Program...... 36 Medicare...... 36 Medicaid ...... 37 Veterans Long Term Care Services ...... 38 The first are for service-connected disabilities...... 38 The second benefit is state veterans homes ...... 38 The third benefit is "aid and attendance " ...... 38

- Funding the Cost of Long Term Care STEP 2 ...... 39

Understanding the Cost of Long Term Care...... 39

Savings or Asset Conversions to Pay for Care ...... 41 Contingency Funding...... 41 You Need to Know How Much to Put Away...... 41 Determining The Amount to Set Aside For Care ...... 42 Sale of Assets...... 43 Sale of a Home You Are Living in to Pay for Care...... 43 Reverse Mortgage ...... 43

Long Term Care Insurance...... 45 Why Buy Long Term Care Insurance ...... 45 Buy Long Term Care Insurance When You Are Younger...46 How to buy long term care insurance ...... 46 LONG TERM CARE INSURANCE BUYING CHECKLIST...... 47

II Using Life insurance to Create Extra Income ...... 48 Getting Money Out of Life Insurance without Dying...... 48 Life Settlements ...... 48

Annuities ...... 49 Income Annuities ...... 49 Deferred Annuities ...... 49 Medicaid Annuities...... 50

Government Programs That Pay for Long Term Care...... 52 Medicare Long Term Care Coverage ...... 52 Medicare Part A ...... 52 Medicare Skilled Nursing Facility--Nursing Home..... 52 Medicare Part A (Also Part B)--Home Health Care... 53 Medicare Hospice ...... 54 Medicare Part B ...... 54 Medicare Supplement Insurance ...... 54 Medicare Part D, Prescription Drug Plans ...... 55 Medicare Advantage Plans ...... 56 Medicaid Long Term Care ...... 57 Income and Asset Eligibility Requirements...... 57 Medicaid Nursing Home Qualifications ...... 58 Seek an Expert on Medicaid to Help You ...... 58 Medicaid Spend Down Strategies...... 59 Medicaid Level of Care Eligibility for Nursing Homes 60 Medicaid Estate Recovery ...... 61 Medicaid Gifting Rules ...... 61 Medicaid Home Care and Community Services ...... 62 Final Note...... 63 Veterans Long Term Care Benefits ...... 64

Planning Strategies for Preserving Assets and Creating Cash to Pay for Long Term Care Costs...... 67 VA Benefit Alternative to Selling a House...... 67 Converting Assets to Income to Qualify for VA Benefit...... 67 VA Pension or Medicaid to Pay Family Members...... 68 Asset Transfers to Qualify for VA Aid and Attendance ...... 68 Dovetailing Veterans Benefits with Medicaid...... 69 Medicaid Spend down for Funeral Trust...... 69 More about Medicaid Annuities...... 69 Medicaid Anticipation Deferred Annuity...... 70 Medicaid or VA Benefits and an Unoccupied Home ...... 70 When the Value of the House Exceeds $500,000 ...... 71

III Transferring Title to Avoid Medicaid Recovery...... 71 Don't Sell the House, Find Strategies for Nursing Home....72 Investment Strategies...... 73 Deferred Annuities Provide Tax Advantages...... 73 Life Insurance for Long Term Care Planning...... 73 IRA or 401(k) Income Life Annuity to Buy Life Insurance...75 Tax Strategies ...... 75 Restructure Insurance and Eliminate Costs ...... 76 Use of Trusts for Other than Estate Tax Planning...... 77 Reverse Mortgage Life Insurance Strategy ...... 78 Reverse Mortgage Long Term Care Insurance Strategy....78

Using Long Term Care Professionals STEP 3 - ...... 79

Long Term Care Planning Requires a Team Approach ...... 79

1. Geriatric and Professional Care Managers...... 83

2. Geriatric Medical Services...... 86

3. Professional Home Care Services ...... 88

4. Home Maintenance, Transportation & Chore Services..93

5. Home Disability Support and Medical Alert Systems ....94

6. Elder Law and Estate Planning Advice ...... 97

7. Elder Mediation Services...... 100

8. Guardianship and Trust Administration ...... 103

9. Financial Services Specialists ...... 106

10. Reverse Mortgage Specialist ...... 107

11. Seniors Relocation and Real Estate Specialists ...... 109

12. Hospice Care Providers...... 112

13. PrePlanning, PreNeed Funeral Providers ...... 114 IV STEP 4 - Creating a Personal Care Plan and Choosing a Care Coordinator ...... 115

PART I – OVERVIEW OF THE LONG TERM CARE PLANNING PROCESS ...... 117 Consider the following example for immediate care ...... 117 The second group for long term care planning ...... 120 Example #1--Planning after Retirement...... 121 Example #2--Planning Prior to Retirement ...... 122

Understand How This Book Becomes Your Care Plan .... 124

Fill out the Care Planning Survey ...... 125

Gather Information ...... 125

Choose a Personal Care Coordinator...... 126

Identify Needed Legal and End-of-Life Arrangements..... 128 Will ...... 128 Living Will...... 128 The Physicians Orders For Life Sustaining Treatment .... 129 Durable Power of Attorney...... 129 Estate Planning -Trusts...... 129 Who-Gets-What-List ...... 130 End-of-Life Services...... 130

Identify Financial, Government & Provider Resources.... 131 Bank Checking and Savings Information ...... 131 Life Insurance Policies...... 131 Health Insurance or Advantage Plan ...... 131 Medicare Prescription Drug Plan Insurance ...... 131 Long Term Care Insurance...... 131 Annuities and Trusts ...... 131 Other Assets ...... 131 Monthly, Quarterly or Annual Income ...... 132 Real Estate ...... 132 Government and Community Services ...... 132 Professional Services ...... 132 Family Mediator ...... 133

V Complete the "Personal Long Term Care Plan" Form ...... 134

Organize a Care Planning and Agreement Meeting ...... 135

Complete a Care Planning Agreement ...... 136 GET IT IN WRITING...... 136 Complete the "Care Planning Agreement" form ...... 138

PART II – LONG TERM CARE PLANNING DOCUMENTS...... 139

Checklist for Making a Long Term Care Plan ...... 141

Care Planning Survey ...... 143

Personal Long Term Care Plan ...... 147

Who-Gets-What-List...... 156

Care Planning Agreement...... 157

Care Planning Agreement (duplicate tearout copy)...... 159

Checklist for Making a Long Term Care Plan (tearout).....161

Table of Contents