by David Bassoni, Reprint from the March 2, 2011 Business Lexington
Long-term care options counseling is a phrase that seems to be appearing with more frequency in the national media these days, and it is a phrase that is used with a casualness that doesn't give much time or attention to what long-term care options counseling is and what it can provide those individuals and families that spend some time working through the various issues and making plans to both finance and guide their own care. A second associated term heard often these days is long-term care planning, which as the name suggests, involves developing and implementing a plan relative to the counseling that the individual or family has sought out.
Long-term care planning is about where and how an individual sees themselves living at the latter stages of life, when that person's ability to meet their own needs and otherwise manage their own personal care and household management responsibilities may be compromised, and assistance is needed to maintain themselves in the place they have chosen to live.
Long-term care planning is about financial responsibility and the control over the direction of one's affairs that comes with having developed a plan, clearly communicated and documenting one's plans and wishes, and making the savings, insurance or investment decisions necessary to provide for that plan.
Long-term care planning is about acknowledging that there are certain elements of aging, and even disease, that we cannot predict and plan for. Understanding that and developing contingencies, and making clear both your wishes and your expectations to others that may become involved in your future care, are all vital. Long-term care options counseling and planning is about doing your homework. It is about understanding the breadth of service options given your wishes to live where and how you choose.
The reason long-term care options counseling and planning has received such a great amount of attention lately is that both state and federal governments are trying to control the spiraling costs of health care and long-term care generally, and certainly one way to go about trying to control some of these costs is to make aware and put more financial responsibility back on the individuals themselves. For example, the cost of a nursing home bed in the commonwealth of Kentucky is approximately $40,000 to $50,000 per year, and after an individual has expended their own monthly income and assets, the state and federal government, through Medicaid, pays for that individual's nursing care.
If, through efforts like long-term care options counseling, state and federal governments can help forestall a nursing home placement for one individual by even six months, they have effectively saved $20,000 to $25,000. And if, through long-term care options counseling, some state or federal agency can encourage or provide information that leads to the sale of a long-term care insurance policy that will pay for thousands of hours of community-based care services on behalf of the insured individual, then again, the state and federal government will save tens of thousands of public service dollars.
So what if all of that seems reasonable, you say. Why would I want to spend so much of my own money to provide for end-of-life care, if the state and federal government are willing to pick up the tab when I have no money? Why wouldn't I just want to spend what I have now on things I want and things I want to do, and let Medicaid pick up the bill when I need that kind of help? Well, one reason — even if you aren't swayed by the argument that we should each, as much as possible, be responsible for ourselves — is that Medicaid and the state and federal tax dollars and governments that pay for Medicaid can't afford you and your care. As baby boomers age into needing the kinds of supportive services being discussed here, there is a greater demand and fewer individuals are paying into the system to support these needs.
Additionally, the costs of these services are expensive to begin with, and their costs are steadily increasing. The combination of less revenue, greater demand, and higher costs means that it will be increasingly unlikely that you will get the supportive services you need, and if you are fortunate enough to be assessed as qualified and don't end up on an extensive waiting list, then you still will have very little control over who will be dispatched to your home or apartment, what services are provided, or when those services are scheduled to be delivered.
And finally, without the supportive services you've needed to get to the present, it is increasingly likely that you will not be living where you choose to live, but rather where you can afford to live. At the very least, you may be living in a setting that has available the supportive services you've come to need, whether or not it is in a community you are familiar with, and whether or not you know anybody there or have access to the conveniences or amenities you think important to your quality of life.
Long-term care options counseling and the planning that grows out of an open, frank and informed conversation about long-term care choices and limits is really about self-determination. It is about the pride that comes from having taken an active role in the planning and provision of one's own care. It is about working with financial planners, health care professionals, aging and social services agencies, housing specialists, insurance agents, employers, family, friends and concerned others to ensure the kind of future you want, as much as you are able to do so.
This article first appeared in the Feb/March 2011 issue of ADD-Vantage newsletter, published by the Bluegrass Area Development District.
