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Making the best care decisions for aging parents

Talking about what to do next is never an easy conversation, but if you plan ahead, it can be less painful for everyone involved.

The holidays can be a wonderful time spent with family you don’t get to see often, but it can be difficult when you notice that mom or dad is starting to seem less like themselves.

Talking about what to do next is never an easy conversation, but if you plan ahead, it can be less painful for everyone involved.

Randy Larson found that out the hard way. When his mom needed immediate care, the family jumped into “go” mode.

"In the beginning there is so much you have to do to just coordinate, and do the paperwork, and the applications, and the discussions, and the meetings, and the phone calls, and the emails and the scanning,” Larson says.

His story isn’t unique. Most families, at some point, have to make the same kinds of decisions.

"Most people are really very overwhelmed by it,” says Kathleen Dempsey.

Dempsey would know. It’s her job at Pathfinder Care Management, to help people like Larson navigate the system.

"I always say the good news is we have a lot of options, and the bad news is we have a lot of options,” explains Dempsey.

Those options range from various levels of in-home care, to independent living, assisted living, all the way up to skilled nursing facilities. The key is to know what level of care you need, and then of course, what you can afford.

“So much is determined by what your finances are,” says Dempsey.

And that is where this gets really tricky. According to Genworth, the average cost for assisted living in the Twin Cities was $4,500 a month in 2017. The average cost for a nursing home? $9,000. $9,000 a month!

Unless you qualify for Medicaid, you will need to pay out of pocket. For those with enough means, no problem. But for those in the middle, which is most people, it could drain everything you have, from your bank account to your home.

“Most people are not planning ahead for long-term care in retirement, just thinking about having that money to retire, let alone having extra money to plan if you're going to be in a nursing home,” says Mike Kojonen with Principal Preservation Services.

Kojonen says the best thing to do is plan early.

"If you're going to buy a long-term care policy, the best time to get that is in your 40s or 50s, when your health is really good, and the cost is cheaper.”

Long-term care insurance is one way to do it. Many employers offer it to purchase as part of your benefits package, and there are a number of options on the open market.

"There are some long-term care policies called a return on premium, which I'm a big fan of," says Kojonen. "You pay a little bit more on it because that's another big fear, 'What if I paid into this for 15, 20 years and I pass away, and I just wasted all this money?' Well, you can put it into an account where if you never used it, that at least that money gets paid out to your beneficiaries."

Both Kojonen and Dempsey from Pathfinder suggest sitting down with an Elder Law attorney, regardless of your assets, because the laws around Medicare and Medicaid are confusing, and every situation is different.

“I think that people are surprised to learn that Medicare does not cover more long-term care services," says Attorney Mary Frances Price. "There is a limited benefit for long-term care services under Medicare but that benefit is intended to get somebody back to independent living, so if it becomes a situation where somebody has advancing memory loss, and they are going to need support for the rest of their life, Medicare is not going to cover that."

And if you think gifting your estate away now will stop you from losing it in the future, just know the government is onto that. Minnesota now has five-year look back period. Any gifts of money or property in the 60 months before applying for Medicaid are fair game.

"I get asked all the time, will they go after my children if my children are the ones who received that? Technically no, what they will do is deny coverage for the person who made the gift,” says Price.

The moral of the story? Plan ahead if you're able. It's tough enough to make the decision to put a parent in someone else's care, let alone have to worry about how to pay for it.

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