Rite Aid is dedicated to helping caregivers take care of their loved ones - and that often means providing answers to difficult questions. Many commonly asked questions may have already been answered by our pharmacists and other experts. You can search here to learn more about Long Term Care.
A: According to the Centers for Disease Control, activities for daily living (ADLs) are simply “activities related to personal care and include bathing or showering, dressing, getting in or out of bed or a chair, using the toilet and eating.”
Assessing limitations in these activities will go a long way in determining if the loved one in your care is still capable of living independently. In the Medicare Current Beneficiary Survey, “if a person had any difficulty performing an activity by him- or herself and without special equipment, or did not perform the activity at all because of health problems, the person was categorized as having a limitation in that activity. The limitation may have been temporary or chronic.”
An assessment of any limitations should be done by your loved one’s primary care doctor. Once that occurs, it should determine if they’d need day-to-day assistance.
Should moving the person in with you—or hiring someone to move in with them—not be a realistic option, the alternatives are to help the person in your care move to an assisted-living community or, in more serious cases, a nursing home.
A: "An assisted-living facility will, in general, provide room and board and help with bathing, dressing and other activities of daily living. Some help with self-administration of medicines," says Robert Mollica, senior program director at the National Academy for State Health Policy in Portland, ME. But, he cautions, policies governing facilities are determined by state and can differ depending on where the facility is located.
The first step in choosing an ALF is to understand the regulations provided by "the agency responsible for licensing facilities. This can be done through your state's public health department or office on aging," Mollica explains. Then you must contact the facility or facilities you're interested in and "see how each facility applies [the state's regulations]. Regulations may say, for instance, that if you develop a health condition that requires nursing care, you can stay. But," Mollica points out, "a facility may choose not to permit that. It's important to understand under what circumstances the facility could ask you to leave."
A: When choosing assisted-living options, the major considerations often are the payment schedule and provided services.
In a Continuing Care Retirement Community (CCRC) "there is a significant investment up front and, in most cases, some kind of monthly maintenance fee," according to Paul Williams, director of state affiliate relations at the Assisted Living Federation of America, in Alexandria, VA. But there's also, as the name suggests, continuing care. "People can enter on a fairly healthy basis, knowing that as they need more services, they have them in a familiar setting. It's a community that has three levels of care—independent setting, assisted living and skilled nursing—so it has the continuum of senior care in one location."
The Fee-for-Service facility typically has no upfront payment but features "a yearly or month-to-month contract." And while not all such communities are affiliated with a care facility, the bottom line, according to Williams is: "You need to have a community that can meet your needs."
Whichever option ends up being right for your parents, it's vital to meet officials and discuss all contracts and care details before making a decision.
A: There's one important number to remember when it comes to taxes and medical costs: 7.5 percent. "Medical expenses are deductible, but they must exceed 7.5 percent of your adjusted gross income. Anything above that 7.5 percent is deductible," says Barry S. Krostich, CPA, a partner in the firm of Krostich & Krostich, LLP, in Roslyn Heights, NY. And that number applies to long-term care costs. "Long-term care expenses include diagnostic, preventative, therapeutic, curing, treating and rehabilitative expenses for chronically ill patients," Krostich adds. "If someone is chronically ill, then long-term care costs that are deductible also include that person's maintenance and personal care expenses. But again, this all applies if the total exceeds 7.5 percent."
For assisted-living care, the deal remains the same, he points out, though facilities may have different policies about what percentage of your fees get applied to medical expenses. "A portion of the monthly rent may be deductible," he says. "In addition, if there are any personal care fees that you pay to the assisted-living center for specific personal medical care, those items will also be added into the pool that must exceed 7.5 percent."
A: “The fifties are the time to start looking at long-term care and to think about your plan for the next ten to twenty years,” says Jeff Mogil, CEO of the Mogil Organization, an insurance-brokerage firm in New York City. Those between 50 and 59 will find the most reasonable premiums for LTC insurance. A single, 56-year-old woman in good health, he explains, would pay approximately $3,500 a year for a policy covering $250 of care per day (budgeting for five-percent inflation) for a maximum of 10 years. That’s assuming a 60-day waiting period before coverage begins. There also are 30- and 90-day options that would, respectively, increase or decrease premiums. “For a lot of policies now, the waiting period doesn’t apply to home health care,” he notes. “It only applies if you go into a facility.” He also says that married couples taking out a similar policy to that of the single woman would receive about a 15 percent discount.
Coverage becomes costlier if there’s an existing illness. A person with diabetes, for example, should expect to pay from 25 to 50 percent more in premiums than a comparably aged person in good health.
Deciding to purchase LTC isn’t easy. Consider your family’s history regarding longevity and chronic illness. Age matters, too; the younger you start, the lower the premium. But don’t start too young since you could end up paying in more than you’ll receive in benefits. And starting at say, 75 to 85, could prove cost prohibitive. You must consider your overall financial picture. Experts caution against taking out a policy with annual premium costs greater than five percent of your current annual income.
Mogil counsels clients opting in favor of long-term care insurance to look for reputable companies licensed in the state where the policy is purchased and protected by the state insurance department to protect benefit payments in case an insurer goes bankrupt. “I’m a little concerned, both as someone who sells it and has purchased it, about whether the money’s going to be there if we’re all going to be applying for benefits at the same time,” he explains.
Also, because some policies cover you only in the state in which the policy was purchased, he recommends you ask yourself where you’ll be living when you retire before committing to an LTC policy.