Be prepared before facing life-changing moves

For more than 50 years, they had made their most important decisions together, but suddenly he alone is responsible for finding the 24-hour care she needs. He now faces a heavy responsibility in the midst of tremendous emotional trauma. Unfortun-ately, his situation is one that is common.

 Forty percent of those over the age of 65 will spend time in a nursing home. A small percentage of those will remain in a facility five years or longer. Aside from those staggering statistics, approximately 70 percent of the 65-plus age group will need some type of health care services as they age. More often than not, those needing long-term care arrive at that point unprepared.

 While it’s hard to know what specific events face us in the future, it’s important to plan.  By taking care of matters such as durable power of attorney, living wills and financial planning before needing long-term care services, the stress of potential illnesses won’t need to be compounded by the pressure to make important decisions without adequate knowledge or information.

 Some of the critical decisions that need to be made when accessing long-term care services are financial. Today, approximately 70 percent of nursing home residents rely on Medicaid to pay for their long-term care. Medicaid was established as a welfare program for the poor, so requirements for eligibility contain eye-opening income and asset restrictions. 

 Medicare pays for a small number (about 10 percent) of those who need nursing home care. Medicare only covers short-term needs; however, it pays for up to 100 days if the stay is necessary for follow-up care after a hospital stay. Other patients generally pay out of pocket. Veterans’ benefits, long-term care insurance and family support are also options that may be considered.  
Insurance of any kind, be it managed care, Medicare Advantage plans, or long-term care insurance, is confusing for all of us. Make sure you
have a basic understanding of what each offers. For example, Medicare Advantage plans offer a hybrid of Medicare and managed care plans and often require out-of-pocket spending. It’s important to know your policy inside and out to avoid the surprise of uncovered costs associated with the care of a complex or chronic condition. Long-term care insurance is a great choice that can enable you to maintain the financial control you’ve worked hard to acquire. 

 Having some knowledge of how to navigate the maze of available long-term care services is also important when faced with the need for an immediate decision. Since making the transition from home to a 24-hour care facility can be overwhelming, knowing where to start to find the facility that’s right for you can make a difficult time a little easier.

 The Rhode Island Health Care Association has a list of skilled nursing and rehabilitation facilities by community on its web site at www.rihca.com. The Rhode Island Division of Elderly Affairs also has information about nursing centers on www.dea.ri.gov as does the Medicare site www.Medicare.gov/nhcompare. References from physicians, discharge planners, friends and family members can be invaluable in steering you toward a nursing center that’s right for your needs.

 As someone who has years of experience dealing with families daunted by the complexity of long-term care decisions, the best advice I can offer is to take a little time to discover the resources available to you or a loved before the need for services arises. A little knowledge goes a long way in diffusing the anxiety that arrives with major health care decisions.


Joan M. Woods is chair of the Rhode Island Health Care Association, which is comprised of about two-thirds of the state’s skilled nursing and rehabilitation facilities, and executive administrator of the Genesis HealthCare Grand Islander Center in Middletown. Contact her at (401) 849-7100 or joan.woods@genesishcc.com.