The Long Journey Home

People misunderstand what it takes to pay for long-term care

Published: Monday, March 13, 2017

The Long Journey Home
People misunderstand what it takes to pay for elder care


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  Jacqueline Mamula uses a walker to get around the LIFE Butler County facility on West Diamond Street. LIFE Butler County has 174 participants and is expanding. 

Nearly 70 percent of those turning 65 will need long-term care at some point, according to the U.S. Department of Health and Human Services.

Unfortunately, a third of Americans 40 and older have done no planning for their long-term care needs according to The Associated Press-NORC Center for Public Affairs Research.
Tim Sechler, a partner at Heritage Elder Law law firm in Butler and Mars, said the state thinks the average cost for a month in a nursing home is $9,792 for a semiprivate room.
Sechler and other local elder care experts often find confusion when they talk to people about financing their elder years.
He said the basic sources of funding for that care are: Medicare, Medicaid and private funding including long-term care insurance.
“There's a big misunderstanding that they've been paying into the Medicare system their whole adult life with the understanding that in retirement Medicare will pay for their health-care needs,” Sechler said. “But, Medicare doesn't pay for a long-term nursing home stay.”
He said Medicare pays for acute medical care but not for long-term care. For example, it covers care for a heart attack but not the full treatment for a stroke.
“About two-thirds of all nursing home residents are on Medicaid across the nation,” Sechler said of the federal/state insurance program for low-income people.
Those who have little or no assets may have Medicaid coverage. Wealthy individuals may be able to pay on their own.
“Middle-class America stands to lose everything,” Sechler said.
“One of the other biggest confusing things is the home issue,” Sechler said.
He said many people fear that payment for nursing home care means giving up their home.
“Medicaid doesn't count it as an available asset, but many people end up losing it later anyway. That's an area where people really should get legal counsel,” Sechler said.
“I have never met anyone who wants to go to the nursing home,” he said. “But the programs that would keep you in your house are more difficult to get on than nursing home Medicaid.”
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  Barb Lewis stretches out during exercising at LIFE Butler County in Butler. 

LIFE Butler County, 231 W. Diamond St., is working on that.

“A very common misconception is that, 'I cannot afford the home care and services I would need to live at home.'” said Janice Rodgers, enrollment manager for LIFE Butler County.
“We pay for comprehensive medical care, in-home care, adult day services and medical transportation,” Rodgers said.
LIFE Butler County is a Pennsylvania waiver program funded by Medicare and Medicaid. LIFE also accepts long-term care insurance and other private payment.
LIFE Butler County is a partnership of Lutheran Senior Life and Butler Health System. It has 174 participants now and is expanding its facility to help more people.
“Our program was designed for the lower-income individual with the option for those with the resources to private pay for them,” Rodgers said.
She said LIFE has different financial eligibility criteria for Medicaid.
If medically necessary, all of LIFE's services can be offered in someone's home.
“Our care is to keep them safe at home,” Rodgers said.
Rodgers said LIFE services for a participant living at home costs the state less than a person in a residential facility.
“The trend at this point in time is home and community-based services,” Rodgers said.
Margaret Clawson, executive director/administrator for the YWCA of Butler, which includes YWCA Personal Care, said there is a public misconception that the low-income elderly have never worked.
“At their heyday, they didn't make very much. They worked very hard,” Clawson said.
She said if they didn't have much money then, their Social Security and pensions are insufficient now.
YWCA Personal Care is nonprofit. Residents pay what they can afford with everyone paying something. Individuals who qualify to live there have private rooms, private baths, health care and other services on-site. 
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Ashlee Perry, an employee of YWCA Personal Care, paints Barbara Steinmetz’s nails at the facility on West Cunningham Street. The home has 37 clients. 

“Everyone is different. We respect that,” she said.

“We're always operating at 100 percent,” Clawson said. The organization serves about 37 low-income, frail elderly people. Not surprisingly, it has a waiting list to get in.
Often families only start considering care for a family member once the person is in the hospital and needing long-term care.
“I don't think people think about it when they (are) healthy at home,” said Debra Monteleone, community liaison for Sunnyview Nursing and Rehabilitation Center in Butler, a skilled nursing center that provides short-term rehabilitation, as well as long-term resident care. Its 220 beds include a 36-bed secure dementia unit.
A review for Medicaid eligibility evaluates the five previous years of a person's finances to be sure the person didn't give away their assets to qualify for Medicaid.
“One of the biggest misconceptions here is that families are not sure about the five-year look back for skilled nursing when you're talking about Medicaid. I think a lot of families make some financial mistakes and then it's too late to correct it,” Monteleone said.
Sechler said records from open and closed bank accounts, savings accounts, investment accounts, life insurance policies and real estate transactions are among the documents required for the review.
“I think families are surprised by all the information they need to have for the Medicaid process to take place,” Monteleone said.
When families have questions about long-term care, she said they can get answers from Sunnyview and other local organizations.
“We have a great resource in our county which is the Area Agency on Aging which is a good resource to start with when anticipating long-term care,” Monteleone said.
Rodgers said people don't realize what is available to help them learn about paying for care. She recommends investigating before it's needed. Community education opportunities include Pennsylvania 211 phone number which has Butler County information and a referral line. 


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