As much as most of us prefer not to think about it, the reality is that we all face the likelihood of physical and mental decline as we age. That means that long-term care, in some form, may be necessary in the future. To ensure that your wishes are honored and that you can pay for the high cost of long-term care (LTC), you should include a long-term care planning component in your comprehensive estate plan. With that in mind, a Grand Forks attorney at German Law offers a North Dakota long-term care planning guide.
Understanding the Need for Long-Term Care Planning
If you turn 65 today, you have almost a 70 percent chance of needing some type of long-term care service and support in your remaining years. On average, you will need that care for about three years, with women needing care for a longer time than men. If you do need LTC, you stand a 35 percent chance of needing nursing home care, a 42 percent chance of needing paid care at home, and a 13 percent chance of needing assisted living. The cost of LTC will be higher than the national average if you are a North Dakota resident, averaging about $150,000 per year for nursing home care, $68,000 for a home health aide, and $40,000 for assisted living in 2022. Add in the fact that at least one in 10 older individuals experiences some form of elder abuse each year, and the need to plan for long-term care should be clear.
Long-Term Care Planning for North Dakota Residents
Long-term care planning is best accomplished by coordinating with your estate planning attorney and those family members who may be faced with providing care for you and/or making decisions for you in the future. Important things to consider when creating your long-term care plan include:
- Your personal health and family health histories. While there is no way to know with certainty who will need LTC, much less what type of LTC will be needed, a good place to start is with your own personal health history and the health histories of your close family members. If you already suffer from chronic health issues, such as high blood pressure, high cholesterol, diabetes, or COPD, your risk for LTC is likely higher. If you have a parent or sibling with heart conditions, you are potentially at greater risk for similar health concerns. Being mindful of health concerns that increase the likelihood that you will need LTC helps you plan for that possibility. In addition, keep in mind that if you develop a chronic health condition it may impact your eligibility for health insurance and/or raise your premiums. If you are still relatively young and in good health, you may wish to weigh the odds of developing a chronic condition when deciding whether to purchase long-term care insurance now.
- Research LTC options in your area. You undoubtedly do not want to end up in a nursing home facility; however, knowing that it is a possibility, choosing the facility yourself offers a sense of empowerment. Be aware that there are LTC alternatives to a nursing home for seniors who need help but who do not need the level of care provided by a nursing home. Popular alternatives include an assisted living facility, community-based care programs, a home health aide, and family caregivers. If a nursing home becomes necessary, you can research licensed facilities by navigating to the North Dakota Health and Human Services
- Share your preferences with your family. You undoubtedly want to remain in your home and age in place. Some seniors can do that without needing any assistance; however, there is a very good chance that you will need at least some help as you experience the physical and/or cognitive decline that accompanies the natural aging process. Do not assume that family members are willing and able to provide unpaid care. Instead, sit down and have an honest discussion about what you want to happen and what they can and will provide if the time comes when you need care. Consider your family dynamics and logistics. If you have multiple children, evaluate their proximity and willingness to assist. If one child lives nearby and is readily available to provide care, while others are distant or unable to assist, it may significantly influence your LTC plan. Keep in mind the toll that providing unpaid care will take on a caregiver. A recent poll found that 13 percent of caregivers had to quit their job to become a caregiver, nearly a quarter (24%) cut their work hours, and almost half (47%) said being a caregiver is a financial burden.
- Address how you will pay for LTC. Knowing the high cost of LTC, addressing how you will pay for that care is essential. Although you will likely rely heavily on Medicare to cover your healthcare expenses as a retiree, Medicare only covers nursing home care following a hospital stay, and even then, only for a short period of time. If you retain private health insurance, it probably will not provide coverage for LTC either as most health insurance policies exclude LTC costs. Purchasing a separate long-term care insurance policy is one option. A LTC insurance policy is one that you typically purchase when you are younger and is intended to cover the cost of LTC if you need it when you are older. Monthly premiums will usually be lower the younger you are when you purchase the policy; however, you will pay those premiums for longer before you need the benefits. Also consider things such as coverage limits and exclusions as well as what triggers benefits under the policy before deciding to purchase an LTC insurance policy.
- Medicaid planning. While Medicare will not cover LTC expenses, Medicaid will. Medicaid is a healthcare program that is predominantly funded by the federal government but is administered by individual states. When determining eligibility, both income and asset limits apply. For 2023, the income limit in North Dakota for regular Medicaid for the aged is $940 for an individual and $1,260 for a couple if both spouses are applying. For institutional (nursing home) Medicaid there is no set limit because all a beneficiary’s monthly income must be paid to the nursing home (minus a personal needs allowance, Medicare premiums, and a spousal income allowance if applicable). An individual applicant cannot have “countable resources” valued at more than $3,000 while the limit for a married couple is $6,000. North Dakota also has a Program of All-Inclusive Care for the Elderly (PACE) designed for individuals who may require nursing home care but would prefer to receive the kind of support that keeps them safely in their homes and communities. North Dakota also has a Family Caregiver Support Program to help support unpaid family caregiver. To ensure that you qualify for Medicaid when the time comes without putting your assets at risk, talk to your estate planning attorney about incorporating a Medicaid planning component into your estate plan now.
Do You Have Questions about North Dakota Long-Term Care Planning?
Please join us for an upcoming FREE webinar. If you have additional questions about North Dakota long-term care planning, contact the Grand Forks estate planning attorneys at German Law by calling 701-738-0060 to schedule an appointment.
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