By Cathleen Summers

According to a study by the U.S. Department of Health and Human Services, “people who reach age 65 will likely have a 40 percent chance of entering a nursing home. About 10 percent of the people who enter a nursing home will stay there five years or more. This year, about nine million men and women over the age of 65 will need eldercare. By 2020, 12 million older Americans will need eldercare. Most will be cared for at home; with family and friends as the sole caregivers for 70 percent of the elderly.”

A new population of seniors and those nearing the senior status are looking for some type of financial means to pay for long-term care in case of failing health. Many have taken care of family members who had no means to pay for their care or have seen their parents entire retirement savings wiped out because of medical and nursing home costs.

Does the government Medicare program pay for long-term care costs?

A statement on the Medicare.gov website clarifies what Medicare will pay for.

“Generally, Medicare doesn’t pay for long-term care. Medicare pays only for medically necessary skilled nursing facility or home health care. However, you must meet certain conditions for Medicare to pay for these types of care. Most long-term care is to assist people with support services such as activities of daily living like dressing, bathing, and using the bathroom. Medicare doesn’t pay for this type of care called “custodial care.” Custodial care (non-skilled care) is care that helps you with activities of daily living. It may also include care that most people do for themselves, for example, diabetes monitoring. Some Medicare Advantage Plans (formerly Medicare + Choice) may offer limited skilled nursing facility and home care (skilled care) coverage if the care is medically necessary.”

How does Medicaid cover long term-care costs?

Fortunately, there is a government program that will help pay for long term care costs — Medicaid. Unfortunately in Massachusetts, this program has strict eligibility rules and will only pay for care for individuals who have less than $2,000 in assets and for couples whose combined assets do not exceed approximately $113,000. All other individuals wanting help from Medicaid must impoverish themselves paying for their own long-term care services first, before Medicaid will help them. In Massachusetts, the cost of privately paying for long-term care is between $11,000 and $13,000 per month. If an individual is unable to qualify for Medicaid, they will need to spend their own assets at the staggering rate of approximately $150,000 per year.

Planning for the final years of life and dovetailing government programs, care provider systems and funding sources can be invaluable yet complicated. This area of planning can be one of the most challenging endeavors undertaken by anyone attempting to help seniors in this final phase of life. It is imperative that the senior work with a knowledgeable professional who understands all of the issues pertaining to long-term care and develop an individualized plan that will help to protect assets, locate appropriate funding and provide the necessary support to ease the burden for the final years of life.