Paying for long term care

What it is/What it costs.

Plan for your care ahead of time.  Or someone else will plan for you later.

Plan for your care ahead of time. Or someone else will plan for you later.

As we age, at some point, it is difficult to maintain our “activities of daily living.”  These activities are exactly what you think they are and include: bathing, dressing, eating, personal hygiene, meal preparation, transportation, transferring from lying to sitting, mobility, and similar tasks that we perform everyday.

There are a number of alternatives as we age, which includes staying at home with private care, living in a retirement facility independently with some amenities onsite, assisted living, memory care, enhanced or specialty assisted living, skilled or rehabilitative care, palliative care, hospice care, or nursing home long term care.

  1. Home care.

This is care by individuals, family members or employees of a home care service, paid for by the hour, scheduled in several hour increments to assist the senior with activities of daily living. The cost will range from $10-$30 per hour, depending on the type and frequency of care and caregiver.  Individuals or family members range from free to $15 per hour, depending upon relationship or finances.  Around the clock care can easily top $12,000.00 per month, so seniors should become educated on their alternatives to avoid impoverishing themselves too early.

  1. Retirement Community

With the population aging, there are a proliferation of options for the client.  From lower income, HUD subsidized apartments to luxury communities with onsite golf courses and yoga classes, it is a great time to be a senior.  Sky is the limit for cost, limited only by the resident’s ability to pay.  Subsidized apartments will typically be subjected to means testing and will have the resident pay a percentage of their income, such as 30%, per month for rent.  Very upscale retirement communities will cost…as much as you want to pay.

  1. Continuum of Care Retirement Communities (CCRC)

These facilities are usually upscale, resort type retirement communities that have a range of care options.  In a typical model, the resident pays an “entrance fee” to the facility, and that fee pays for an independent living villa or apartment, with graduations of care available on site, so that as the client’s health declines, he or she will move within the same facility to a higher level of care as needed.  The advantage is that the model will often stabilize the cost of care, with a flat rate available no matter how ill the resident becomes, thus the resident is pre-purchasing the care needed.  Other options for this model include an estate payback of a large percentage of the entrance fee, or having the resident remain even if the resident has run out of money.

  1. Assisted living

For those seniors that need hands-on care with some activities of daily living, assisted living will often be the choice.  Residents live in a small apartment in a facility that will give them a great deal of independence, but often have nurses and aides onsite to care for their day to day needs.  The resident must qualify for this level of care, and may require more care than the facility is able to offer, thus the resident may have to go to a higher level of care or the facility risks being subject to state sanctions.   Costs vary wildly in any given area, from $50 a day to $300 a day.  If the resident becomes ill, extra help by the hour might be imposed by the facility as a condition of remaining on premises until other housing can be located.

  1. Memory care

Memory care is a relatively new concept, born of the epidemic proportion of Alzheimer’s dementia and the variety of regulations on assisted living facilities.  Memory care in an intermediate step between assisted living and the nursing home for long term care.  The resident who cannot recall the nature and manner of dispensing their medicine may be very independent, and not yet ready for the nursing home and, conversely, may be subject to wandering – limiting nursing home choices.  In this case, the resident can live in relative comfort in locked part of an assisted living facility, often surrounded by aides specially trained in handling dementia patients.  The cost will typically be twice or more the cost of an assisted living facility (where the residents do not have to be monitored constantly).

  1. Specialty assisted living.

Similar to memory care, specialty assisted living care would be for those residents of assisted living who no longer physically qualify, who do not want to go to the nursing home.  Often, the resident still has a higher quality of life and does not want to be in the nursing home, which represents a much higher separation from the community.  The cost will be comparable with memory care.

  1. Skilled nursing home care

If you fall, break a hip, or have an acute health care crisis, you will often be admitted to the nursing home care or rehabilitation center, short term, for a stint of rehab.  Medicare will pay for up to 100 days of rehab in the nursing home.  Most insurance policies will pay for only the first 20 days with a large copay for the next 80 (this year $157.50 per day).  It is possible, and preferable, to switch policies once rehab begins to take advantage of a plan that will pay for the entire amount to maximize rehab days.  To qualify, the client must spend 3 days at the hospital, then be ordered into at least 2 different types of qualifying therapy.  Therapy beyond insurance coverage runs thousands and thousands of dollars per month.

  1. Rehabilitative care

Rehabilitative or home health care is an alternative to the SNF days, where you return home to recuperate, and the rehab staff through home health comes to your home (or assisted living, independent living, etc.), to perform the rehab several times a week.  The therapy is ordered by the doctor and the cost is paid through Medicare.  Like SNF, it can be terminated if progress stalls.  Out of pocket for rehab beyond Medicare runs into the thousands per month.

  1. Palliative care

Palliative care is an intermediate level of care, between rehab and hospice.  Not available in all areas, palliative care represents a necessary transition for those  who are declining but could medically or therapeutically benefit by additional rehab type benefits.  Where available, Medicare covers these services through Part A, similar to rehab or hospice. It is of relatively short duration, several weeks at best.

  1. Hospice care

Hospice care will be for those who are terminally ill and not expected to survive more than six months.  Those on hospice care will not qualify for rehabilitation or similar restorative care as the focus is on comfort only.  Medicare part A covers all costs of hospice care, including medication.  This is true even if you on a Medicare Advantage plan.    There are a number of levels of hospice care.  Beware, as only the highest level will also pay for the cost of room and board in the nursing home, but many  believe that once hospice care has been ordered, then the nursing home bill is paid.  This is rare!


  1. Long term nursing home care (ICF)

The final, and highest level of care, will be long term care in a nursing home.  There are no insurance options available, other than long term care insurance.  The cost will run from $6,000 to $10,000 per month.  Keep in mind that your loved one, especially if they are suffering from Alzheimer’s dementia, may not qualify for long term care in every facility.  In some instances, if the behavior of your loved one is poorly controlled, they may require admission to a geriatric psychiatric hospital for stabilization, and in rare cases, transfer to a multi-diagnosis, specialty long term care facility.