Three Tips For Talking To Your Older Clients About Long Term Care
When you look at an older client’s portfolio, the biggest concern is probably about whether they have enough to last to the end. You calculate the drawdown, the earnings, and you spend time on those figures. But what about long term care?
This is the conversation the client doesn’t want to have. No one wants to think about being disabled or losing independence.
Of course, this is not realistic. You, the planner may not want to bring up the subject because of your own discomfort, or because you aren’t sure what to say, or perhaps because your client dismisses it if you do bring it up. But a competent planner and advisor must do so.
Consider this realistic typical scenario:
A health crisis happens to your client. It can be a fall, a stroke or heart attack, anything that is unexpected. First, there is a hospitalization. OK, Medicare covers that, together with supplemental insurance. A rehab facility is next with therapy and nursing care. Medicare covers that but only to a point. When the elder is ready for discharge, the client and family are told, sometimes a day or two beforehand, that they will have to get help for the aging loved one at home. ”Doesn’t Medicare cover that?” they ask. Unfortunately, no, they are told.
The Cost
So the family members and the client start scrambling to provide help at home. In some parts of the country the cost is about $30 per hour. According to the Genworth 2015 Cost of Care study, the national median price for someone to provide help with bathing, dressing and walking or other hands-on home help is $20/hour.
When you do the math, you realize that even if your client needs just twenty hours a week at the average cost, it will add up to nearly $20,000 a year. That is on top of other, non-covered medical expenses, such as physical therapy when Medicare stops paying, hearing aids, and many medications. And that is just the beginning. Limited hours of home care often stretch into full time care as people who have disabling conditions age.
Some people figure they can spend their assets and give things away so they can qualify for Medicaid. I would not recommend Medicaid as the best way to get quality care. First, one must be really destitute to qualify for it. And the state looks back at all financial transactions for a five year period in most states prior to the application to see what was going on, what transfers were made and if they were honestly done. Second, the care one receives under Medicaid is the most basic, may be of the lowest quality and typically is not what anyone really wants.
If you can prevent that choice, you will. Your client could spend her last days in a three bed room in a dingy nursing home if she or anyone in her life thinks Medicaid is a fine way to pay for care.
The cost for quality care at home can be staggering. In my own prosperous county, with a very high elder population, the cost of 24/7 care at home from non-nursing providers (home care workers) exceeds $200,000 per year. That is on top of the ordinary costs of living a senior has, regardless of care. And she will still be paying her out of pocket costs for other things Medicare does not cover: many medications, other non-covered services, Medicare premiums, etc.
Taking On The Long Term Care Discussion: Three things you should do
- You need to create a plan for how to pay for long term care in the future as part of your job of financial planning and retirement planning. Your client is not likely to ask you about it. Do not wait to have these discussions. Cash for the unexpected need for care could be a major expense. Your client needs to know the facts and figures. Most people grossly underestimate the costs. We have even seen financial industry publications naively state “Medicare pays for most things”. It doesn’t pay for what most people need to stay at home after any disabling condition arises.
- Educate your client about the likelihood of this need for future care.About 70% of people will need long term care in some form in their futures. Failure to plan for it can bankrupt a person or leave them in serious debt toward the end of life. Or some investments could make cash inaccessible when needed.
- Use resources to help yourself understand the real costs of home care, assisted living, and nursing home care. In order to educate your client, you need to educate yourself first. The Genworth Cost of Care study is a good resource. Here at AgingInvestor.com, we also offer tools[1] to help you. Be sure you have something to hand to and to discuss with your client. The need is now for any retiree.
by Carolyn Rosenblatt, RN, Elder Law Attorney & Dr. Mikol Davis, Geriatric Psychologist
[1] The Family Guide to Aging Parents: Answers to Your Legal, Healthcare and Financial Questions, and Succeed With Senior Clients: A Financial Advisor’s Guide To Best Practices and Working With Aging Clients, A Guide for Legal, Business and Financial Professionals. All 3 books are available at AgingInvestor.com and Amazon.com
