Financing care for older adults is full of challenges
By Jenny Wagner, Beaver County Times, Pa. | |
McClatchy-Tribune Information Services |
It's why the family stepped up to help after Smarsh's 94-year-old mother had a medical emergency seven years ago and had to move to an assisted-living center, where she still resides.
"You don't even think about doing it differently," Smarsh, 68, said. "Either you have that commitment to family or you don't, and fortunately, not only do we have it at my generation, but my children are following suit."
The
Many people don't know where to begin when an older loved one needs long-term care, and evidence shows they often don't think about their own care down the line either, or how they will pay for it.
NAVIGATING SYSTEMS
The first step for many local older adults and families who need help financing care is the
"A lot of times, the first call in is, 'We just know we need help; we don't know what kind of help or what we're looking for,'" said McDermitt, who also handles information and referrals.
The office distributes a "Benefits and Rights" handbook published by the
"They should -- especially if they're thinking about their parents and what their parents' needs are -- they really should think about long-term care insurance for both themselves and their parents," Sullivan said. "They should think about just understanding reverse mortgages, so that you know in the back of your head that it is available if need be, and think about what improvements can you make to your home that would make your home long-term livable. And those are good investments in your own long-term care."
According to a recent report from the senior care website Caring.com, more than half of family caregivers have not planned for themselves for life insurance, burial insurance, retirement, long-term care insurance or senior living communities.
The annual Senior Care Cost Index surveys online users to measure how family caregivers of older adults in
Sullivan admitted people don't always want to think about the fact that they might not be healthy or able to live independently someday, but Smarsh knows from caregiving that planning is important.
"It's totally going to be your job to investigate what's out there, what you may or may not qualify for, and in most cases, you can go jump through all kinds of hoops and still get turned down," Smarsh said.
Many programs also have lengthy applications, complex rules and requirements, and call for personal documents and paperwork to be in order.
"You can call an agency based on somebody else refers you here, and then they'll say, 'Well that's not really us, you need to call the state on this,' or, 'You need to call the welfare office on this,'" Smarsh said. "And that's what gets to be really frustrating, trying to chase down leads."
CAREGIVING COSTS
A 2013 report from the
Informal care alone topped
Family caregivers rarely are paid for what they do -- Sullivan and McDermitt noted that some programs provide reimbursement for supplies, or cover expenses for respite time -- and they often must pay for caregiving costs out of their own pockets.
Nearly half of family caregivers spend more than
In
The annual cost of home care, which includes home health care and housekeeping services, is about
In 2010, approximately one in eight people age 85 or older were living in a nursing home or long-term care facility, according to the CBO. It's estimated that 70 percent of people over age 65 will need some type of long-term care in their lifetimes, though what type and how long is unpredictable.
Smarsh's family decided that assisted living was the right place for her mother, since she would have around-the-clock personal care, as well as socialization and other comforts. Smarsh's mother would be eligible for
"The fact that somebody is in another location and not in your home does not lessen the amount of work that's on your plate to take care of on their behalf," Smarsh said.
Smarsh is an organized person, but managing her mother's medical and living situations has meant meticulous note taking and record keeping.
"You have to scrutinize everything, you have to pay attention to everything," Smarsh said. "Every statement, every bill, anything that comes in the mail related to their care, you better line-item it because you find mistakes and then it's your job to make it right."
It also includes not always taking "no" for an answer. Smarsh appealed a couple of denials on her mother's behalf and the decisions were overturned.
"You have to be vigilant, you have to speak up when you need to speak up because you are that person's caregiver, you're their lifeline to get the best care for them," she said.
OPTIONS AND ENTITLEMENTS
Many people have misconceptions about the services and programs available to them as they age, and one of the biggest, Sullivan said, is that
Beyond short-term rehabilitation or a similar temporary stay, people have to foot the bill or -- once they've spent down their assets -- go on medical assistance (
"So anybody who is in the nursing for a lengthy period of time, unless they're very wealthy, is going to wind up on medical assistance," she said.
For middle-income individuals who want to leave something to their families, it can be a big dilemma.
"The value of that home should be used for your care," Sullivan said. "The assets that the person has amassed through their lifetime should be utilized to give them the best possible care that they can receive, and that's in-home care, too."
Sullivan encourages people to make adjustments to their homes so they can stay as long as possible, and to look into options such as reverse mortgages and long-term care insurance as well.
"If you need a first-floor bathroom, or you need a stair (lift), or you need a lift chair, or you need all three, why not spend your
Long-term care insurance can be expensive, and experts and policy makers have been exploring ways to make it a viable option for more people. But Sullivan said the right policies also can help people provide a lot of care -- in-home as well -- that otherwise would end up depleting their assets.
Reverse mortgages also can help older adults stay in their homes and finance long-term care, but Sullivan said it's important to educate themselves about the process first, starting with the
Long-term care insurance and improving a home or downsizing to a more manageable one are the best options because they give people a choice, Sullivan said.
"They get to live where they want to live, and they get to enjoy remaining in their home, and get to stay independent," she said.
"That's all of our goal, is to remain independent as long as possible," McDermitt added.
RETIREMENT AND REALITY
Smarsh retired just before her mother became ill, but many caregivers find themselves struggling to balance careers with the new responsibilities, and sometimes they have to leave the workforce altogether.
Baby boomers who are now beginning to retire want to maintain a certain lifestyle in retirement, but many experts warn that the generation's savings fall short, especially when health issues and long-term care needs are factored in.
Locally, one of the issues that Sullivan has seen is a workforce that had its retirement pulled out from under it by the collapse of the steel industry.
"With the steel mills shutting down in the '80s the way they did, a lot of baby boomers didn't have enough years to earn a retirement," Sullivan explained. "If you got laid off in the mill when you were 37 years old, you might put together a career of being a handyman and driving a school bus part time ... and part-time jobs in construction or whatever you could get, but none of that generates a traditional retirement, nor does it generate enough income to really save."
It has become necessary for a lot of older adults, especially those without savings, to work longer to support themselves, and sometimes other family members.
The SEP program, which serves
The jobs are temporary and participants must set goals and work toward finding unsubsidized positions, but they receive training along the way in things such as computer and technology skills and networking, which can help them to compete with a younger workforce,
"The whole point is to help them develop skills, to push them beyond their comfort zone a little bit, learn new technology, brush up on things," Manzo said. "A lot of times they're applying for jobs that they just don't have the qualifications (for), and then they get discouraged because nobody's hiring them."
SEP participants -- who must be 55 or older, unemployed and make less than 125 percent of the federal poverty level -- often say they didn't know the program existed.
"They're so grateful to find it," DeCaria said. "They're older, and they still have to work."
After caring for loved ones for about 20 years, Smarsh said she and her husband look at life in retirement differently now. They've always tried to live frugally, but it has made Smarsh even more conservative financially than she was.
Someone who has gone through it "is just much more cognizant of what life could have in store," she explained.
"Until you do, it's like anything else, if you haven't walked in the shoes, you may think you know because of what people tell you, but you really don't."
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