Long-term Care Medicaid vs Insurance: What's the Difference?

In health care settings, the body gets medical attention, but the mind and soul matter, too. Older adults in medical care face a battery of health questions, but too often the most consequential one goes unasked and unanswered: What does a good day look like for you today?Medicare requires people to receive a spiritual assessment within their first five days of admission into hospice. Many states allow a nurse to conduct the initial spiritual assessment, but I think it helps both the person and the health care provider for the assessment to be done with someone who has theological training. Many have been certified in clinical pastoral education, or CPE. Nurses can get so focused on the technical to-do lists of medical work  the measurements, the tests, the drug regimens that it can be hard to make time for the issues that matter most to the living human, namely, their happiness, peace and contentment.  As a spiritual care provider with 17 years in senior care facilities, and as a chaplain in the Army National Guard and Air Force National Guard, I have counseled hundreds of people in the final days of their lives.  For older adults and their families, one of the most valuable resources is also little-known a Medicare option that provides spiritual counseling for people in hospice. Longing for ConversationToo often older adults in care are being talked at, not listened to. Many times, I've found that people in the last chapter of life want to discuss their path to the end more than their medical professionals and, especially, more than their loved ones.  It often helps to have that discussion with a professional who is trained to hear them, and, if requested, to comfort and advise them.  RecommendedOpinion: Why I Went on Hospice Even Though I'm Not Dying | Personal PerspectivesThe code of ethics for the leading chaplain and spiritual care associations all prohibit proselytizing. A spiritual care provider should be able to work with someone on their own terms, no matter their beliefs. The United States may be turning more secular, but the fact remains that older adults are the most faith-affiliated of any demographic age group.This initial spiritual meeting is likely to be about the basics: Is the person religious? What is their support system? Will a certain faith-based ritual bring meaning or comfort? Do they have a preferred faith leader? Or is a secular discussion a better fit for the person's beliefs? 

Guardianship is a serious legal process that serves as a last resort for caring for an elderly parent who can no longer make sound decisions for themselves. It requires a court hearing and confirmation of incapacity by medical providers.What is Guardianship?Guardianship means an individual is appointed by the court to make medical decisions and manage daily care for an elderly parent. This typically occurs when an elderly parent:Is diagnosed with cognitive impairments like dementia or Alzheimer's diseaseHas suffered brain injuriesExperiences serious health conditions that impair decision-making abilitiesKey Considerations in GuardianshipEmotional ChallengesDeciding to pursue guardianship often involves mixed emotions. Adult children may feel uncomfortable, especially if family members disagree about the necessity of guardianship.Legal RequirementsTo establish guardianship, documentation must be submitted to the court that:Substantiates the degree of cognitive impairmentProvides evidence of poor decision-makingIncludes a medical assessment, potentially a neuropsychological evaluationTypes of GuardianshipGuardian ResponsibilitiesMake medical decisionsManage daily careAdvocate for the elderly parent's best interestsFollow the principle of substituted judgment (making decisions the parent would make)ConservatorshipIn most situations, a conservator is also appointed to manage money and property. This can be the same person as the guardian or a separate individual.Challenges of GuardianshipAdvocacy and Medical InteractionsGuardians must:Navigate complex healthcare systemsCommunicate with medical professionalsUnderstand and research medical conditionsMake thorough, prudent decisionsFamily DynamicsGuardianship can create:Potential conflicts between family membersDisagreements about care and spendingEmotional stress that may damage relationshipsState-Specific ConsiderationsGuardianship laws and terminology vary by state. Some states have:Different definitions of guardianshipVarying availability of professional guardiansUnique legal frameworks for elder careImportance of PreparationRecommended StepsHave early discussions about care preferencesDocument the elderly parent's wishesUnderstand the full scope of guardianship responsibilitiesSeek support and resources for caregiversAs the population ages and chronic diseases become more prevalent, understanding guardianship becomes increasingly important for families caring for elderly parents.

Considering senior living as the best option for you or a loved one? If youre just beginning, the search can often feel daunting. And knowing where to look for possible financial resources can seem like a mystery.Its often helpful to approach this as a step-by-step process. Answering the following questions can help get you off to the right start: What lifestyle, amenities and services are you looking for? Is help needed for physical or cognitive issues? If yes, at what level? Which of the 4 basic types of senior living listed below would provide the best fit? What is the cost of senior living? What options may be available to pay for senior living? Basic categories of senior livingFollowing are 4 types of communities available: Independent Living: Private residences for older adults to continue living independently and enjoy the activities, amenities and services offered. Assisted Living: Private residences and assistance with the activities of daily living, such as bathing and dressing. Amenities and other social activities included. Long-Term or Skilled Nursing Care: Full-time care by a trained staff for those requiring medical care for rehabilitation or for long-term chronic conditions. Memory Care: Specialized care for those with Alzheimers or dementia, included as part of assisted living, long-term care or in a stand-alone community. The cost of senior livingPrices vary among communities, services offered and locations. Talk to an associate at a specific community to confirm costs. Be sure to clarify what services are included or can be contracted for an additional fee.How to pay for senior livingEach type of senior living may have varying costs and different payment sources available.When you visit a community, theyll provide you with more detailed information about financial options. We also invite you to download our free guide The Dollars and Sense Guide to Senior Living.The following list offers an overview of a few of the financial resources that may be available, as well as options you might not have yet considered. Private money Personal funds are typically used to pay for independent living, the majority of assisted living and a smaller amount of long-term care. Some states do accept Medicaid for certain assisted living costs.Personal resources could include: Cash Checking and savings accounts Salaries, if youre still working Social Security payments Dividends distributed Investment accounts Retirement or pension plans Long-Term Care Insurance Depending on the policy, long-term insurance may cover the cost of home care, adult day care, assisted living, memory care and long-term care. These policies are sold by private insurance companies and other businesses or as additional insurance offered by employers.The cost of a policy is based on the age of the person at the time of purchase, amount of insurance, time period covered, deductible and any special options. Veterans Benefits Veterans or their surviving spouses may be eligible to receive monthly benefits to help cover the costs of senior living if they meet certain income and personal care qualifications. Known as Aid and Attendance, this federal benefit is offered through The Department of Veteran Affairs. It can help pay for care in the home, assisted living or a long-term care community. Life insurance conversions Your life insurance policy may be transferred to a financial account that provides monthly benefits to help pay for home care, assisted living, long-term care and hospice. These funds wont count as an asset in the Medicaid spend down process, described below. Your home Seniors may have equity built up in their home, which can provide a source of funds. If youre moving into a senior living community, selling your home may provide the money you need.Other financial options that your home may offer include: Access to cash through a home equity loan A line of credit based on your homes equity Reverse mortgage which also considers a homes equity. This funding is only available if one of the owners remains living in the home. Renting out your home. If your home is paid for, the rent received could be applied toward senior living expenses. Medicare Medicare is a federal health insurance program and will only pay for long-term care if you require rehabilitative care at home or in a nursing home, for a limited period of time and if you meet certain restrictions. It doesnt pay for general personal care, assistance with the activities of daily living, or room and board. Medicaid Medicaid will pay for long-term nursing facility care but in order to be eligible, you need to qualify for having limited financial resources. If you do have assets, however, you would need to spend them down in order to qualify. As a joint federal and state program, states may offer some assistance with assisted living costs.Considerations when calculating the cost of senior livingPeople often assume its less expensive to remain at home instead of moving to a community. But that may not be true. Look at the big picture when considering the costs of home vs senior living. If your home would need expensive renovations to make it accessible or if you would need to contract for services to come into your home, the costs may be more comparable than you might have thought.But dont forget to account for the non-financial benefits and advantages. If the safety and quality of life for you or your loved one can be achieved more successfully in a senior living community, youll want to consider the tradeoff of any monetary savings.