We hear it constantly, right up until a hospital discharge planner explains that going home isn’t an option.
“I’m never going to a nursing home, so I don’t need to plan!” We’ve heard this time and time again. According to the Pennsylvania Health Care Association, 70% of people turning 65 will require long-term care in their lifetime, and of those requiring care, it will be for an average of three years. In the Commonwealth of Pennsylvania, there are approximately 700 nursing homes, which at any time are around 80%-90% occupied. That means there are over 80,000 nursing home residents in our state right now. It may be time to start planning.
Of course, that’s not the only long-term care “plan” we hear. There’s “My wife will take care of me,” usually said while she’s sitting right there, rolling her eyes. There’s “My kids will take care of me,” usually said when the kids aren’t in the room. And our personal favorite: “I’m just going to take a long walk in the woods.” We laugh right along with them. But a punchline isn’t a plan, and reality has a way of stepping in.
Hospital discharge is a large factor in nursing home admissions. Your loved one may have spent time in the hospital and is now being discharged, but isn’t well enough to return home. Whether the hospitalization resulted from surgery or a recent illness, if the individual can’t safely return home in their current condition and the hospital isn’t going to be paid for additional time, the hospital will want the patient to leave. At that point, a nursing home becomes the best option, and the patient is sent there for physical therapy. They receive physical therapy, occupational therapy, speech therapy, and other services to prepare for a return home. And there it is — time in a nursing home.
Another factor in nursing home placement is the death or illness of a caregiver spouse. Receiving care from a spouse sounds ideal in theory, but it isn’t a realistic long-term plan. When one spouse becomes the primary caregiver, that person begins to neglect their own needs, and daily stress starts to take a toll on their health. If that caregiver spouse then becomes chronically ill or passes away, the spouse they were caring for can end up in a nursing home anyway.
According to AARP, nearly 1 in 5 family caregivers provides more than 40 hours a week of care. But when caregiving duties collide with a career, children, and other personal responsibilities, maintaining that level of care becomes extremely difficult — especially once it includes bathing, dressing, and toileting. Once again, a parent ends up in the nursing home.
Why does this matter? The average cost of nursing home care in Pennsylvania is $12,811.50 per month. Three years of long-term care would cost roughly $461,214.00. Are you prepared for that?
Many people turn to long-term care insurance to prepare for this possibility, and it can genuinely help — but it has shortcomings worth understanding upfront. Almost every policy has an exclusion period on the front end, typically 100 to 120 days, meaning you’ll pay for the first four months out of pocket before you can make a claim. You also only receive the benefit you contracted for: maybe $100 a day, with a lifetime maximum of $200,000 or two years. Very few policies cover 100% of the cost indefinitely. And the coverage has become cost-prohibitive for many families — by the time most people start thinking about it, they already have health conditions that make coverage expensive or unavailable. Those who bought early can often afford the initial premiums, but as they retire, the ever-increasing premiums become unaffordable, and the policy lapses right around the time it might actually be needed.
That leaves Medicaid. For some families, Medicaid is already part of the plan. For others, it’s something they hope to avoid at all costs because they’ve heard that relying on it means losing the family home or a lifetime of savings. That fear is understandable, but it’s often based on incomplete information. Pennsylvania’s Medicaid rules are complex — there is a five-year look-back on gifts and transfers, specific protections for a spouse who remains at home, and rules governing what happens to the house — but with the right planning, most families can qualify for benefits while protecting a meaningful portion of what they’ve worked for. Even families already facing a crisis often have more options than they realize. The key is getting guidance before decisions are made, not after, and that’s exactly what we help families do every day.
If a hospital discharge planner called about a parent tomorrow, would your family already have a plan?
Have you actually priced out what three years of nursing home care would cost your family — or are you hoping it won’t come to that?
If you have long-term care insurance, do you know what it truly covers, and what it doesn’t?
No one wants to think about needing long-term care. But it’s more likely than not that you or someone you love will. It isn’t something to avoid — it’s something to plan for, with guidance from an experienced elder law attorney. The possibility isn’t remote, and the consequences of ignoring it can be devastating.
Contact our office to set up a Strategy Session by calling 724.942.6200 or visiting our website at ZacBrownLaw.com.
