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Long-Term Care Through the Windshield

Long-term care (LTC) risk and costs are staggering.

At age 65, you have a 70 percent chance of needing LTC some day and a 20 percent chance of needing five years or more. Nursing homes average $75,000 per year; assisted living, $36,000; and home care costs $20 per hour.

So people must be scared to death about LTC, right? Wrong.

Most people see LTC risk and costs through the rear-view mirror if they think about them at all, and many don't.

That's because, ever since 1965, if Mom and Dad or Grandpa and Grandma needed long-term care, they usually received it in a nursing home funded by Medicaid or Medicare at little or no cost to themselves or their families.

So, why worry now?

Because everything is about to change! The bottom is falling out of the social safety net. Here's what you'll see if you look at LTC risk and cost through the windshield.

  • Medicaid is bankrupting state budgets and driving federal debt through the roof.
  • Medicaid pays largely for nursing homes which most people want to avoid.
  • Medicaid pays nursing homes less than the cost of providing the care.
  • Medicaid has serious problems of access, quality, reimbursement, discrimination and institutional bias.
  • Medicaid depends heavily on Social Security income that recipients are forced to contribute, but Social Security has a $16 trillion unfunded liability.
  • Medicaid depends heavily on generous Medicare provider reimbursements, but Medicare has an $86 trillion unfunded liability.
  • Government LTC financing has doubled in the past 30 years while private financing of LTC has dropped by half.
  • Only 10 percent of Americans have private LTC insurance even though few can self insure for the risk.

In other words, the social safety net that has protected the poor, middle class and even the affluent for decades will be a sieve not a savior in the future.

Smart people will plan now for LTC. Look through the windshield at what's coming not through the rear view mirror at what has been. Get advice.

But beware the lure of "Medicaid planning," lawyers who will tell you they can save your assets and get the government to pay for LTC. That option will close before you need care.

Instead, consult an expert on responsible long-term care planning. Whether you decide to save, invest or insure for LTC, make this your guiding principle:

To guarantee quality long-term care in the most appropriate and desirable setting, you must be able to pay privately. That's true already. It will be more true in the future.

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