re insurance policies can insure your golden years and your financial c„ assets. But there ci) are pitfalls. NORINE ZIMMER Lu SPECIAL TO THE JEWISH NEWS „ person doesn't have to be 80 or 90 to understand that there comes a time when the proud de- sire for independence turns into frank acknowledgment of de- pendence. Nor is it surprising that no other part of the healthcare system generates as much passionate concern and de- bate as long-term care, given the growth of the vulnera- ble aging population. We face a complicated and in- timidating maze of types of care, suppliers of care and ways of pay- ing for it both as an aging nation and as consumers. Nationally, more than half of all nursing home expenses are paid out-of-pocket by individuals and their families, and less than half are paid by state Medicaid programs. Neither Medicare, Medicare supplemental insur- ance nor employer-provided health insurance will pay for most long-term care (LTC) ex- penses. Medicare will cover the cost of some skilled nursing care in ap- proved nursing homes or in your home, but only in certain situa- tions. Medicare does not cover nursing home care except for 20 days in skilled nursing care and only immediately after discharge from hospital. Yes, it pays a little on the next 80 days in a nursing home, but not enough to make a dent in cov- ering the expenses. Medicare does not cover custodial or inter- mediate care. Medicare and Med- icaid have their own definitions of skilled nursing care which don't necessarily match those de- Norine Green Boner is a practicing gerontologist and resident of Huntington Woods. finitions found in long-term care cause of prolonged illness or dis- ily members. It's complicated and policies. ability. It's also a phrase used to confusing determining which ser- Medicaid, the healthcare pro- describe healthcare and other vices and living arrangements gram for the impoverished, picks services. will best meet your needs. up the tab for 69 percent of the LTC is provided by home care current 1.5 million nursing home agencies, senior centers, adult TYPES OF CARE residents. But, these nursing day care centers, traditional Skilled nursing care is ordered homes may not be the one you'd nursing homes, continuing care by a physician, involves a treat- choose for yourself or a parent. retirement communities or fam- ment plan, care is administered Medicaid eligibility requires means-testing and meeting federal poverty guidelines. Your spouse at home will be allowed to keep some of your income and assets. Based on studies done at the Brookings Institution, Employee Benefit Research Institute and Brandeis Uni- versity, a substantial portion of Medicaid nursing home res- idents weren't poor before they entered the nursing home and might have been able to afford insurance. Most studies sug- gest that between a quarter and a third of Medicaid nurs- ing home beneficiaries were admitted as paying residents. What made them poor was the $46,000-a-year average cost of nursing home care. This is where private LTC in- surance comes in to fill what could be a huge gap between what government covers and what people have to pay out- of-pocket. Medicaid planning for many families was to transfer assets from seniors so that af- ter three years they could be poor enough to qualify for Medicaid to cover their nurs- ing home expenses. But, as of Jan. 1, 1997, a new law makes this a felony. So let's get going. What is long-term care (LTC)? It's the kind of help you need ifyou're not able to care for yourself be- Paul Kadish explains a policy to Ben and Sue Morris.