Falling off a financial cliff without Medicare to catch you

Many spouses or adult children of seniors come to see me when their loved one has been admitted to, or is soon going into, a nursing home for long-term care. They are traumatized over their loved one's situation, of course. Often they are feeling completely blindsided, having recently learned that contrary to popular belief, Medicare isn't going to pick up a dime of the enormous cost. If the person in my office is a spouse, he is usually frightened out of his wits that he'll have nothing left to live on. Everyone's looking over a financial cliff and just realizing that Medicare won't soften the fall.

It's a myth that Medicare pays for long-term, custodial care. The sooner you realize that, the sooner you can make preparations should you ever need such care, and the more assets you can preserve.

I think the Medicare myth persists because of the term "nursing home." Nursing home really refers to two entirely different types of care:

• Skilled Nursing Care. Medicare pays for skilled nursing, to a limited extent. This is the type of care designed to restore someone to a prior level of functioning. If you are admitted to a hospital for 3 days and then discharged into a skilled nursing home facility, Medicare will cover 100% of your expenses for 20 days. For day 21 - 99, assuming you are improving, Medicare will continue to pay, but you will be required to pay a premium, too (starting at $137.50 daily). After day 100, you are on your own.

• Long-Term Care Nursing Care:  You are always on your own, as far as Medicare is concerned. Long-term nursing care is custodial care. It is not designed to improve the patient's functioning. Custodial care provides assistance with daily activities like bathing, toileting, eating, transferring from bed to chair, etc.  

How likely is it that you or someone you love will need long-term care? A good chance. And unless you're very wealthy and/or have adequate long-term care insurance, long-term care could well wipe you out financially. According to the U.S. Department of Health and Human Services, over 40 percent of those over 65 will need long-term care in a nursing home for some period of time. The HHS further reports that in 2009, the average cost for a semi-private toom in a nursing home was $198 per day, and for a private room, $219.00. Few families can shoulder that expense for too long before going broke.

Make plans to protect your family and your assets. Seek assistance from a Florida Bar Certified Elder Law Attorney, preferably in advance of a crisis. Strategies exist that can allow you to preserve assets and keep you from falling off that financial cliff. Your attorney can advise you about Medicaid benefits and even V.A. benefits that your loved one may qualify for without losing everything first.