When her husband was diagnosed with dementia in 2012, Dianne Bryant was grateful for the long-term care insurance policy he had purchased years ago.
"He was always a stickler about getting good insurance," she says.
Marc Bryant has Lewy body dementia with Parkinson's disease, which doctors believe was probably triggered by head trauma when he captained the football team at Texas Tech as a young man. The brain disorder ultimately left him unable to care for himself. Round-the-clock care soon became too much for Dianne so she began looking for an assisted living community. But when it came time to file a claim with the insurer, it wasn't easy.
"There were so many hoops to jump," she says. "It was a nightmare."
Many seniors and their families face this dilemma. Not only do you need to find a place that offers good care, you need to figure out a way to pay for it.
The cost can be astronomical. Assisted living communities averaged $4,350 per month in the Dallas area in 2018, according to Genworth's Cost of Care Survey, an annual report by the long-term care insurance company. Skilled nursing was even more: $5,064 for a semi-private and $7,134 for a private room.
About 70 percent of people over age 65 will need some type of long-term care during their lifetime, according to the U.S. Department of Health and Human Services, and generally the cost isn't covered by health insurance or Medicare.
Brace yourself: There are no easy solutions. But here are some tips to consider.
The veteran connection
As a World War II veteran, Becky Clay's father qualified for the Veterans Affairs Aid & Attendance pension benefit, which can help pay for assisted living or skilled nursing care.
"The Navy had lost all of his medical records of his injury from a bomb blast while serving near Okinawa," says Clay. "A typhoon had destroyed or blown them away. I had to resurrect people, eyewitness accounts, documents and even a captain's diary of the events of that specific day in 1945." Eventually she was able to collect the needed paperwork and won the benefit.
Veterans 65 and up who have served during a wartime period (combat deployment is not necessary) may qualify for Aid & Attendance, which pays up to $2,120 a month for those who meet income restrictions. But applying can be arduous.
"Don't attempt to do this alone," cautions James Henderson, interim director of Dallas County Veterans Services. While the VA's website has instructions for applying, he adds, "It won't give you the ins and outs of what you need to do to file successfully. A county veterans service officer can help walk yosu through the process, submit the documents and advocate for you."
The VA considers each application individually, including the veteran's income, assets, and medical and care expenses. To qualify, the senior must reside in an assisted living or skilled nursing facility, receive in-home care or require the aid of another person to perform everyday functions like bathing, eating and dressing. Technically, veterans or their spouses may qualify with assets up to $127,000, but most successful claimants have assets under $50,000. Once you've assembled the paperwork and submitted an application, expect to wait four to five months for a decision.
Henderson advises those in Dallas County to call the Veterans Services Office first for a quick phone consultation to determine eligibility. If you qualify, you'll schedule an appointment with one of the agency's four service officers, who will assist in gathering documentation and submitting an application.
Expect to hit snags along the way, Clay warns. "You need a lot of tenacity and patience to apply for this benefit," she says.
Be careful: The Federal Trade Commission warns that unscrupulous brokers posing as "veterans advocates" are targeting veterans, urging them to transfer assets to a trust or to invest in insurance products in order to qualify for Aid & Attendance.
"What they don't reveal is that these transactions could mean that the veteran loses eligibility for Medicaid services or loses the use of their money for a long time," the FTC's website reports.
Medicare/Medicaid
Medicare may pay or partially pay for a short-term stay -- up to 100 days -- in a nursing or rehab facility following a hospitalization. However, Medicare does not pay for long-term residential care. For low-income seniors, Medicaid may be an option.
"For most seniors, Medicaid is generally the last resort," says Carl Burlbaw, assistant director of the Elder Financial Safety Center at the Senior Source. "It's very strict as far as how much you can have in assets and income." Other than a home and a car, the senior may have assets of only $2,000 or less.
Your choices are limited, too, if you rely on Medicaid to pay. Some private-pay senior communities do not accept Medicaid at all; others may accept it for only a limited number of their beds.
If you have assets now but expect to run out of money down the road, you'll fare better if you plan ahead. Seniors who pay for their own long-term care and eventually run out of money may be able to remain in a nursing home or assisted living facility if they qualify and a Medicaid bed is available. Get expert advice from a trusted attorney or advisory service such as the Senior Source. Applying for Medicaid can take months, and timing is tricky -- your eligibility can be pushed back if you apply too soon, such as while your asset level is above the eligible range.
Note that Medicaid does a five-year "look-back" in determining eligibility. Giving your assets away to a child or other family member to make yourself look indigent on paper can disqualify you from receiving Medicaid for a period of time.
Long-term care insurance
Long-term care insurance isn't an option if you're already looking for senior care; generally, you must purchase it before age 65 and while you are still healthy.
Filing a claim can prove daunting, as Bryant discovered, and patients must meet certain qualifications. Usually, they're unable to perform on their own at least two of the six activities of daily living, which are eating, bathing, dressing, toileting, bathing or showering.
Bryant's advice: "Get someone with knowledge in insurance to help you with the process."
She turned to the Senior Source's Burlbaw.
"Be clear as to what types of facilities you can receive care from," Burlbaw says. "Typically, that's going to be a skilled nursing or assisted living community that's licensed. That's important when it comes time to claim."
If you do have a policy, read the fine print now. Some policies require a waiting period of 30 to 60 days, for example, during which you'll have to pay for care out of pocket. If you're still paying premiums, make sure you have a secondary person listed on the policy who will be contacted should you miss a payment because of a hospitalization or debilitating condition.
"Unfortunately, we've seen clients who lost their coverage, after paying for years, because of lapsed payments," Burlbaw says.
Lower-cost alternatives
Finally, remember that traditional senior living communities aren't your only option.
If one or more family members can handle some of the caregiving, consider cobbling together a part-time care plan. Home health care is not inexpensive, but a few days of help each week may save money compared with the cost of a residential care facility. If the senior can be transported easily, adult day care averages around $1,400 a month in the Dallas area, according to the Genworth study. It's a good option for working families caring for a senior with dementia who may be relatively healthy but needs activities and supervision during the day.
Smaller residential care homes can be considerably less expensive -- about $2,000 to $2,500 a month and up. Homes with four or more residents must be licensed by the state; those with three or less are typically unlicensed, but don't dismiss them, advises Laurie Brownlow, founder of iNavigate Senior Living Solutions.
"I work with a lot of unlicensed residential care homes that do a good job," she says. "And I've seen a few licensed ones that are terrible."
Generally, residential care homes are too small to offer amenities like beauty salons or full-time activity directors; Brownlow says that high-functioning seniors can benefit from those extras in traditional assisted living. Those who need constant, personalized care may fare better in a small home. By relying on home health nurses, hospice, visiting doctors and mobile services such as X-rays or dental care, many can provide care equivalent to a skilled nursing facility. Most don't advertise, so you may need do some digging or work with a local adviser like Brownlow to locate one.
"We really look at the care needs of each patient," Brownlow says. "Not every home can meet everyone's needs."
Resources
The Senior Source: The Elder Financial Safety Center offers unbiased, professional assistance for older adults applying for benefits or navigating insurance. 214-823-5700, theseniorsource.org.
Veterans Services Office: It offers assistance in applying for the Aid & Attendance benefit. Call first for a phone assessment of your eligibility or to schedule an appointment.
Dallas County: 972-692-4939
Collin County: 972-881-3060
Denton County: 940-349-2950
Genworth: The long-term care insurance company offers information on the costs of senior care and how to pay at genworth.com.
Medicaid: Find information online at medicaid.gov/medicaid-and-you.
iNavigate Senior Living Solutions: The free service helps clients find residential care homes in the Dallas area. Homes pay a fee for placements. Find it at inavigatesls.com.