Cost of Residential Care
The cost and quality of care for those providing memory (Alzheimer’s/Dementia) care can vary. It is important for you to know who is providing care for your loved-one and understand their values. Below are some examples of the cost of care for a late-stage Dementia resident in their own home, in a facility and in Golden Brook.
Comparing Different Types of Care
Type of Care
Typical Cost of Care
Costs are typically $27 ~ $33/hour. If your loved-one suffers from late-stage Dementia they will likely need 24-hour care. This would cost approximately $21,600 a month at $30.00/hour for 24-hour care.
Important Considerations
Type of Care
Typical Cost of Care
Important Considerations
Type of Care
Typical Cost of Care
Important Considerations
It is very important to know who you are doing business with and understand their business and personal values. These facilities vary greatly in price, amenities, regulatory compliance and quality of staff. It is important to do your “homework” or you may be disappointed.
Type of Care
Typical Cost of Care
The cost of a Golden Brook shared suite starts at $4,000 and is all-inclusive – there are no hidden costs.
Important Considerations
How to Pay for Memory Care
Long-term senior care can be paid for privately and/or with public funds. Paying for memory care out-of-pocket gives patients and their advocates the most freedom in terms of choosing providers. When personal funds can’t cover expenses, resources from the government and nonprofit foundations can help meet the need. Golden Brook can guide you through options. You can also hire an estate planner, geriatric planner or similar finance expert. Below are key payment options.
PRIVATE PAY
Paying for memory care on your own saves a lot of paperwork and proverbial red tape. For example, it lets you skip applications for aid. It can also help keep your loved one off a waiting list. Payment might be accomplished with a combination of sources such as:
Family income Savings and annuity payments Cashing out investments
Borrowing from life insurance
Selling a home
Getting a reverse mortgage
Medicaid is available to people who have exhausted their other payment resources. To qualify for Medicaid, yet still keep wealth in the family, sometimes a person can minimize their assets in specific ways. An estate planner or geriatric planner can provide personalized advice. Here are some general points about personal payment sources mentioned above.
SAVINGS & ANNUITIES
When a person has a good deal of savings, buying an annuity can help ensure that the nest egg lasts. When you buy an annuity, you pay a lump sum and then receive monthly payments for the rest of your life. The monthly payments might not cover all living expenses, but they ensure regular income nonetheless. Another benefit of buying an annuity is that the lump sum paid is shielded from consideration on Medicaid applications, although the monthly annuity income needs to be reported.
BORROWING FROM LIFE INSURANCE
Life insurance policies that are “whole” rather than “term” can be tapped to help pay for memory care and other senior health care needs. (A term life policy can be converted to a whole life policy to take advantage of these options.) The three options with a whole life policy are:
cashing out
selling the policy to a third party
converting the policy from insurance to “assurance”
A portion of each whole term life insurance premium payment is put into savings. One option for memory care payments is cashing out a life insurance policy to access the accumulated savings. This is called getting “accelerated” or “living” benefits. A fee for cashing out diminishes the return though; the policyholder will receive a lump sum that’s worth about 50 to 75 percent of the actual amount saved. Another option is to sell the policy to a third party specializing in life settlements or senior settlements. This would give the original policyholder a lump sum of cash. The buyer would then take over the premium payments and take the financial benefits when the person passes away. Converting a life insurance policy is another option. Life insurance conversion or “life assurance” might greatly reduce the overall value of a policy, but it will let funds be used for memory care. At the same time it will preserve the death benefit for the policyholder’s beneficiaries, which isn’t the case in the other scenarios.
SELLING A HOME
Selling the senior’s home can relieve a family’s financial worries regarding memory care. Still, ideally the home wouldn’t be sold in a rush. One option is to secure a bridge loan. A bridge loan assumes that the home will sell, and it can pay for memory care and other needs until the home sale money is received. Often the first loan payment isn’t scheduled for 90 days. For a family member instead of the homeowner to handle the sale, power of attorney or guardianship will need to be granted.
GETTING A REVERSE MORTGAGE
Loan Reverse mortgage loans let homeowners borrow money for senior care. The maximum amount available equals the accumulated equity in the home. The main advantage of choosing a reverse mortgage for long-term care is that while one spouse moves to a memory care facility, the other half of the couple can keep the home. The main disadvantage of a reverse mortgage is that the loan becomes due when the second person no longer lives in the home. In most cases the home must be sold in order to cover the loan payment, so reverse mortgages aren’t the best choice when the objective is keeping property in the family.
LONG-TERM CARE INSURANCE
Long-term care insurance can pay partly or entirely for memory care and other long-term senior care. Having long-term care insurance gives patients more flexibility in choice of residence compared with using taxpayer funds. An insurance policy must be purchased years before the benefits are needed. Generally, a good strategy is to buy long-term care insurance in your fifties because the rates will be lower compared with buying a policy later. A long-term care policy will generally have restrictions about when residential care will be provided. Normally the requirements aren’t difficult to meet in the case of patients with Alzheimer’s and other dementia. A typical standard for coverage is that the individual needs help with at least two activities of daily living according to a doctor’s analysis.
MEDICARE
Medicare offers very limited assistance to the typical senior in need of memory care. To qualify for Medicare coverage initially, a person needs to require a minimum of a three-night stay in a hospital. For that coverage to continue, they’ll need to require intensive assistance but not custodial care (long-term care regardless of medical need). Medicare will pay for up to 100 days of medical care in such cases. If care in a psychiatric hospital is needed, the limit is extended to 190 days.
Note that Medicare is almost exclusively for medical care. Medicare will not pay for personal care, for instance, unless it’s part of hospice care in the last six months of life. Supplemental Medicare insurance, or Medigap, will typically pay 20 percent of the nursing home care bill not covered by Medicare. Often dementia patients meet the Medicare criteria for a short period of time but then move into the “custodial care” category. In such cases a new form of payment is generally required. When the individual cannot cover payment privately, families in some states are eligible for a Medicare-Medicaid partnership program called Program of All-Inclusive Care for the Elderly (PACE). PACE provides adult day care and in-home care.
MEDICAID & STATE PROGRAMS
Medicaid is funded federally and by the states. Each state operates its Medicaid program separately, and memory care benefits vary accordingly. States can support a wide variety of medical and non-medical assistance programs with their federal dollars. Unfortunately these programs have enrollment caps and seniors are sometimes put on waiting lists. While some Medicaid patients live in nursing homes, others use a state Medicaid waiver program to receive personal care services at home.
Most states use the Medicaid Home and Community Based Services Waiver, or HCBS Waiver, for this purpose. These services are not specific to Alzheimer’s and other dementia. A person getting these services would not get the various therapies offered at high quality homes, unless those therapies were provided by others. Additionally many states have their own assistance programs for low-income people who need help with activities of daily living. These programs aren’t necessarily tailored for those in need of memory care. Many are designed to help delay or prevent moving to a nursing home.
VETERANS BENEFITS
Veterans who need memory care can get tailored skilled nursing services through the Veterans Administration (VA). Their families can also take advantage of VA respite care. Depending on geographic region and the family’s preference, respite care can be provided in the home, in adult day care or elsewhere in the community. A veteran who does not have a spouse or other caregiver may qualify for the VA’s Community Residential Care (CRC) program. CRC is specifically for veterans who do not need nursing home care yet cannot live at home because of medical or cognitive/psychiatric conditions. The care can take place in an assisted living center, a group home, a psychiatric residential care home or similar setting. More than 1000 locations across the country are approved by the Veterans Administration, and veterans can choose from any of the facilities.
If more advanced care is needed, the Veterans Directed Home and Community Based Services (VD-HCBS) can step in. VD-HCBS lets veterans who are candidates for nursing home placement to receive skilled care at home or in independent living communities. Veterans receive funds to essentially become employers; they are free to choose their own care providers In some cases family members can be paid for their caregiving.
Another benefit for veterans and their surviving spouses is an increase in the Aid and Attendance pension based on caregiving needs. Aid and Assistance increases are based on financial need and require a doctor’s recommendation. State-level programs such as California’s CalVet also offer supervised environments and high-level care for vets dealing with confusion and other symptoms of dementia. To learn about these benefits and other memory care for veterans, contact the VA.
GRANTS
National nonprofit organizations give grants for respite care. Some give caregiving funds directly to families. Others grant the funds to local nonprofits and care providers for distribution. To learn more, you can start by contacting the Alzheimer’s Foundation of America and the Alzheimer’s Association.
source: seniorliving.org
