Paying For Long-Term Care

By Jen Ballantyne, Elder Law Attorney

Jen Ballantyne is an elder law and estate planning attorney in private practice at Estates and Elders Law PLLC. Jen’s legal career was “inspired by mom.” As a caregiver during her mother’s six-year journey with Alzheimer’s, she developed a passion for helping other families navigate the challenges of aging and disability. Here, Jen shares a preview of a presentation she will be giving at the Spokane Alzheimer’s & Dementia Conference on May 24, 2022. A similar session will be held at the Tri-Cities Alzheimer’s & Dementia Conference on May 18, 2022. Click here for more information.

When an elder or a disabled person needs long-term care, the individual must pay the cost using long-term care insurance, from income and private funds, or from government needs-based benefits like those available from the Medicaid program. 

The current cost of long-term care in Eastern Washington ranges from $6,000 to $15,000 a month, depending on the care setting and the level of care an individual needs.  

Medicare does not pay for long-term care.
It comes as a surprise to many people that Medicare — the federally-funded insurance program, which is an entitlement for those older than 65 or who have been deemed disabled — does not pay for long-term custodial care. Medicare pays for medical care for services it does cover. A Medicare supplement plan, sometimes called Medigap insurance, typically covers the services Medicare does not cover, although it will also not pay for long-term care. 

Medicare will pay for short-term rehabilitation in a skilled nursing facility as long as the individual is willing to participate and can make progress. After 20 days, the individual is responsible for a co-pay for each day’s care up to 100 days. A Medigap plan may cover these co-pay charges. These 100 days are not guaranteed and when Medicare stops paying, the Medigap plan will also stop paying.  

Medicaid covers long-term care, but you must qualify.
Medicaid is NOT an entitlement program, but a needs-based program. An individual must apply and qualify medically and financially on the basis of need. This program is funded by the federal government and the State of Washington and administered by the State. Typically, the fastest way to secure government needs-based benefits to pay for long-term care is to apply for Medicaid benefits. 

To qualify medically, an individual must require assistance with two or more Activities of Daily Living (ADLs) because of physical or cognitive disability. This includes eating, bathing, transfer, bed mobility, locomotion, using the toilet and medication management.

To qualify financially, cost of care must exceed the individual’s income and there must be less than $2,000 in countable resources in his or her name. To qualify as a married person, resources of both spouses are considered.

An individual can receive help paying for care at home, or “in the community” which includes adult day care, an adult family home or assisted living. The COPES program, or the Community First Choice (CFC) program for low-income persons, provides services in these settings.  

If an applicant’s ADL needs are such that only a skilled nursing facility can meet them, an individual can also receive help paying for care through Medicaid’s Long-Term Care program for nursing home residents.

Guidance and support are available.
The costs of long-term care can be daunting. The process for securing funds to help pay the costs can be difficult to navigate. Often there are other family members and their support and care needs to consider. Whether you have the opportunity to anticipate long-term care needs and costs for you or a loved one, or you are in a crisis with an immediate need to locate and pay for long-term care, help is available. 

An elder law attorney who does Medicaid work makes an excellent guide for long-term care needs. The Alzheimer’s Association can provide a list of these attorneys in your area. Their 24/7 Helpline is 1.800.272.3900. You can also search for an attorney statewide through the National Academy of Elder Law Attorneys (NAELA), Washington Chapter (WAELA) website. Both the WAELA website and the website for Washington Law Help provide detailed information you can use to educate yourself about the Medicaid program.

If you cannot afford the services of an attorney, the Home & Community Services (HCS) unit of Washington’s Department of Social and Health Services (DSHS) accepts and approves Medicaid applications. HCS Spokane can be reached by calling 509.568.3700. Find your local HCS office here.

Aging and Long-Term Care of Eastern Washington funds a non-profit, Community Living Connections (CLC), that can provide information about Medicaid as well as many other services. The Spokane number is 509.960.7281. To find your local Area Agency on Agency, visit the CLC website.

We are so fortunate to live in Washington, a state with social policy that demonstrates it wants to take care of its elderly and disabled population. Washington’s Medicaid program is progressive and available to those who need to access long-term care and Medicaid as a pay source. It provides great peace of mind to families in need.

Family care partners and professionals are invited to join us for an upcoming Alzheimer’s & Dementia Conference in Tri-Cities on May 18 or Spokane on May 24. These annual events provide attendees with valuable education, information and resources — as well as inspiration and encouragement for the caregiving journey. Learn more and register today!

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