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Planning for long-term care is a difficult task. It involves understanding and making decisions about services and options that are unfamiliar to many of us. These include services and supports, housing and financing options, and legal issues. Before you go to the Planning Steps below, it might be useful to find out what you know and don't know by taking the Planning “IQ” Quiz.
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- Assess Your Risk of Needing Long-Term Care Services
While you can never know for certain if you will need long-term care, assessing your risk factors can help you understand if you are at a higher or lower risk. Begin by talking with your doctor about whether you might be at increased risk based on your medical and family history or lifestyle choices. You will gain a better understanding of your risks, and your doctor may be able to help you decrease your risk. You should also review other risk factors, such as gender, listed in the Understanding LTC section of this website.
- Think about Where You Want to Receive Care
If you were to need care for an extended period, where would you want to receive it? If you need more information on long-term care services, review the list of services and providers in Understanding LTC. One way to find out what services are in your community is by contacting the Administration on Aging's Eldercare Locator . [offsite]
- Talk with Your Family
Do you have family (spouse, adult children, siblings) or friends who would want to or be able to care for you if you became ill or disabled for a long time? How do you think you would feel about relying on their help?
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- Review Your Current Insurance Coverage
Do you know if your current health care insurance would pay if you needed to be in a nursing home or needed care at home for an extended illness? Unless you have purchased a specific long-term care insurance policy, your existing medical coverage, Medicare, Medicare supplement, or HMO will provide little if any coverage for long-term care. Review the policies you have with your insurance advisor or benefits counselor to learn what is covered and what is not.
- Decide if You Can or Want to Pay for Long-Term Care Privately
If you don't have coverage for long-term care or prefer to pay out of your own resources, do you know if you would be able to cover all the costs from your retirement income and savings? Think about the financial resources you have and how you feel about using them to pay for long-term care. This could include various sources of income (for example, Social Security, pension, interest income, dividends from investments, payments from an IRA or 401 (k)), as well as cash, savings, stocks and bonds, and your home.
The Long-Term Care Savings Calculator can give you a rough idea of how much you might need and whether you would be able or want to use your private resources to cover long-term care services.
- Investigate Future Insurance or Benefits You Expect or May Qualify for in Retirement
It is important to know and understand what your future benefits will cover, if you are not yet retired. If you only have Medicare, even with a Medicare supplemental plan, most of your long-term care services may not be covered. If you have limited resources, now or in the future, Medicaid may pay for your services. More information on Medicare, Medicaid and other public programs can be found in the Paying for Long-Term Care section of this website. You can also go to the Centers for Medicare and Medicaid Services [offsite] web site for more information on Medicare and Medicaid.
- Find Out What Other Resources Can Help Cover Long-Term Care Expenses
Most people currently don't have coverage or do not have enough private funds to pay for all their long-term care needs, particularly if service needs are extensive or last a long time. There are an increasing number of private payment options available for this purpose. Two of the more common options are long-term care insurance and reverse mortgages. Review private financing options carefully to ensure that you understand all the details, eligibility requirements, and costs. Read about the range of private long-term care financing options in the Paying for Long-Term Care section of this web site.
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- Home Modifications Might Help You Stay in Your Home Longer
Most people prefer to remain in their own homes and consider alternatives only if their care needs cannot be met at home. Modifying your home is an important option that can improve your safety and help you perform daily activities such as bathing and cooking. Home modifications range from grab bars in the bathroom and improved lighting to handrails and wider doorways for wheel chair access, or even adding a bathroom on the first floor of a two-story home for someone no longer able to climb stairs.
Some state and local governments have programs to provide loans and grants to help you pay for home modifications.
- Consider Moving to a More Suitable Environment
Perhaps moving to a new home will best help you meet your future needs. Consider the variety of options such as moving to a house, condominium, or apartment that is all on one level, or that has elevators instead of stairs. Perhaps you would prefer a small, easy-to-care-for apartment with basic modifications already in place.
Other housing options include Group Homes/Board and Care Facilities, Assisted Living Facilities, and Continuing Care Retirement Communities. Information about these housing options can be found in the Understanding LTC section of this website.
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What is Advance Care Planning?
Advance care planning is the process of discussing, determining and executing treatment directives - such as a Living Will, and appointing a health care proxy decision maker for care in the event that a person is not able to make medical decisions for him or herself. Advance Care planning can make a critical difference in your life, and the lives of the ones who care about you, either in emergency situations or when facing end-of-life care situations.
To be most effective, advance care planning needs to be a comprehensive, ongoing process that includes your family and friends, your proxy, and your providers. Planning should reflect your personal values and beliefs, and be adaptable if circumstances change.
Advance Care Planning Considerations:
● Communication
Communication is the single most important first step in advance care planning. It is critical to consider what you want while you have time to think through the options clearly, and then to discuss your options and preferences with your family and others. While advance care planning may be difficult and emotionally charged, communicating your wishes ahead of time decreases the chance of future conflict and takes the burden off your family.
Several issues should be carefully considered for advance care planning.
- Values and beliefs. Personal concerns, values, spiritual beliefs or views about what makes life worth living are important issues to consider when developing an advance care plan.
- Preferences. Most people have ideas about the ways they wish to face death and/or disability, but may be uncomfortable discussing them. Sometimes sharing your own ideas, if you are helping someone, or reviewing the situations of other family or friends who have been in relevant situations can help.
- Health care proxy: Decide who you will appoint as your health care proxy (surrogate or agent) decision-maker. Appointing a proxy is a very important decision. The person you choose as your proxy needs to be able to make decisions based on understanding and respecting your values and beliefs about care. Select someone who you believe will understand and be able to carry out your wishes even if they include denying life-sustaining treatments.
- Help with Planning. Many different kinds of professionals can assist you in creating advance directives that help ensure that your wishes will be respected. Lawyers, social workers and members of the clergy are obvious examples. Some counselors and social workers – especially those who work for hospice services – are uniquely qualified to offer guidance at all stages of the advance care planning process.
What types of Planning Documents do I need?
- Advance Directive – Living Will and Medical Powers of Attorney
Advance Directive is a general term used to describe two types of documents – living wills and medical powers of attorney. These planning documents allow you to convey the type of care you want if you cannot speak for yourself including the extent to which you want life-sustaining medical treatments, and who should make those decisions if you cannot. Advance directives are not only focused on what treatments you don’t want, they also should include all of the treatments you do want.
- Living wills (sometimes called medical directives) are written instructions for care in the event that you are not able to make medical decisions for yourself. Currently, 47 states and the District of Columbia have laws authorizing living wills. State law, however, can vary on signing requirements and other aspects of a living will, so it is important to check on your state’s requirements when completing a living will.
- Medical Power of Attorney (sometimes called a health care or durable power of attorney) is a document that appoints a particular person as a health care proxy or health care agent to make health care decisions for you if you are unable to do so yourself (not just during a terminal illness). A health care proxy is your substitute decision-maker. All 50 states and the District of Columbia have laws recognizing health care powers of attorney. Some specify the types of decisions that health care proxies can make.
- Do Not Resuscitate (DNR)
Do Not Resuscitate (DNR) is a physician’s order that is written in a person’s medical record indicating that health care providers should not attempt life-saving measures such as cardiopulmonary resuscitation (CPR) in the event of a cardiac arrest (commonly known as a heart attack) or respiratory arrest. A request for a DNR can be included in your planning documents, or communicated directly to your physician. Also, most health care facilities have a Do Not Resuscitate order policy and forms that a hospital professional can help you with if you choose this option after being admitted to a hospital.
Steps to Insure that Your Advance Care Planning is Carried Out
- Complete a living will and a medical power of attorney. If possible, you should consult with a lawyer or other professional regarding specific state laws or regulations related to these planning documents.
- Insure that your family and other important people in your life understand what your wishes are, and what is included in these documents. It is particularly important to discuss your decisions with the individual who will be your health care proxy to be sure he/she is comfortable with that role, and can be available to carry out your wishes.
- Keep your planning documents easily accessible and in multiple places. Consider carrying a wallet card with you. Give copies to family members, friends, your physician, and/or your lawyer if appropriate. It is critical that your health care proxy has a copy, or can access a copy quickly, if there is an unexpected emergency.
- Review your plans periodically to be sure that you are still satisfied with your decisions, and your health proxy is still able and willing to be responsible for carrying out your plans.
For help with Advance Care Planning go to the Information and Resources section.
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