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Nursing homes are remarkably expensive, costing an average of $111,325 a year for a private room in the Milwaukee area, according to a survey by Genworth Financial, a life insurance company. Shared rooms aren’t much cheaper and still cost about $101,500 a year. “Assisted living” developments run about $50,500 annually for a one-bedroom unit in […]

Nursing homes are remarkably expensive, costing an average of $111,325 a year for a private room in the Milwaukee area, according to a survey by Genworth Financial, a life insurance company. Shared rooms aren’t much cheaper and still cost about $101,500 a year. “Assisted living” developments run about $50,500 annually for a one-bedroom unit in the metro area, and a full-time home health aide costs about the same, according to the Genworth survey. How does anyone afford such costs? The truth is, most people don’t. According to a review by the University of California-San Francisco, about 80 percent of all elder care is performed by family members.

“People do OK as long as their loved one is someone who can care for them at home,” says Margaret Hickey, a Milwaukee lawyer specializing in elder law. Then things get tricky. Most of Hickey’s clients don’t have long-term care insurance, which would pay for nursing home and assisted living care. Premiums can be steep. Group rates may defray the cost, as can signing up with a spouse, but premiums tend to rise as applicants get older.

Another elder law lawyer in the city, Jaclynn Lephardt, says she’s worked with “very few” clients willing to pay for the coverage. “They’re put off by the premiums they’re seeing,” she says, leaving few options for cash-strapped seniors.

The Affordable Care Act (aka Obamacare) isn’t helping much, either. Fran Halas, an independent adviser on health insurance, says coverage under the exchanges created by the ACA ends at 65, when the limited benefits provided by Medicare kick in. But Medicare isn’t exactly a money tree, with its huge deductibles and lack of prescription drug coverage. In the case of nursing homes, it covers only 100 days.

Otherwise, there’s Medicaid. Qualifying is complicated. You can’t have more than $2,000 in assets, and state officials may place liens against whatever property you own under the poorly understood “Estate Recovery Program.”

“People don’t want to lose their house,” Lephardt says, which can happen, but not while you or a disabled dependent is still living in it. The upshot is placement in a Medicaid-approved nursing home bed, of which there are a limited number. Private money opens up more options, as does prior service in the military. Veterans may qualify for a monthly subsidy or even a bed in one of the state’s three Veterans Homes, a perk for which there’s a long wait list, Hickey says.

In practice, seniors often piece together a patchwork of health care coverage, community services and family support. In Wisconsin, the federally funded 

Title 19 programs, part of the Social Security Administration, can go a long way to postponing or altogether avoiding a nursing home stay. For example, the state-administered Community Options Program provides housekeeping and personal care services.

“I always say we’re going to get through this,” Halas says of her early meetings with clients. However, “I don’t see the tension going down until they get coverage.”
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