Aging is a wonderful thing. In addition to beating the alternatives, it raises a number of challenges and opportunities about where you will live as you age.
Most of us want to stay at home. We value our privacy. We love our gardens and having plenty of space for having friends and family to visit. We also continue to be independent.
We also must acknowledge that most of us will need help. An estimated 70% of individuals over the age of 65 will need some form of long-term care. There are many agencies and services that can provide care at home. The cost can be significant. The benefits are obvious.
If you have long-term care insurance, it may or may not pay for the cost of home care. Such policies typically come into play only when you need a very high level of care. For example, many policies state that the benefits will be provided only if you need assistance with the “activities of daily living,” which include such things as help with eating, bathing, personal hygiene and transferring safely in and out of bed.
If you self-pay for care at home, the cost can be extremely high. Private agencies will typically charge between $30 and $38 per hour for caregivers. The monthly cost can run anywhere from $1,000 to $10,000. Keep in mind that your financial resources exist to give you comfort and the best possible quality of life. You care about your kids, but you come first.
You also have to think about your estate planning documents. Your revocable living trust and your durable power of attorney identify a successor trustee or attorney in fact, someone who can pay your bills if you become incapacitated. The same individual would effectively be responsible for your quality of care. The person named in your advance directive will be involved in your health-care decisions whether you are at home or in a care facility.
Rather than stay at home until and if care in a facility is needed, many opt for a life-care community, also known as a continuing care retirement community. Examples in the community include The Terraces at Los Altos and The Forum at Rancho San Antonio. The idea is to receive whatever level of care that you need at a single facility. This includes independent living, assisted living and the highest level of care – functionally the equivalent of a nursing home. There are many reasons why this is attractive. Onsite care is available, along with supervision of care. The burden is taken off your children or other family members. It takes the guesswork out of finding a placement when care is needed, and a husband and wife can be in the same community even if they receive different levels of care. Also, the food tends to be very good!
But congregate living is not for everyone. For an individual who is used to his or her privacy, it may be uncomfortable to have many family members visit, having moved from a 3,500-square-foot house to a one- or two-bedroom apartment. The “moving-in cost” can range from $500,000 to $4 million.
If you are considering a continuing care retirement community, be sure to talk with your attorney to review the contract.
Here are some things to think about:
• Is the facility solvent? If a substantial payback to your estate is due upon your death, does the facility have sufficient reserves to properly compensate all residents?
• The contract will no doubt provide that the facility staff decides if and when you must move to a higher level of care. Neither you nor your physician will have final decision-making authority.
• While the idea is to stay at the facility even if a higher level of care is needed, every contract indicates that there may not be a vacancy in the assisted-living level of the facility or in the skilled-nursing level of care. If that happens, the facility has the right to place you in a facility somewhere else in a community. This can shatter the dream of most couples, which is to remain together for life.
We have many clients and friends who live happily in life-care communities. We have as many or more who choose to age in place at home. The key is making an informed, proactive decision. Talk with your attorney, your family and your health-care team as you consider your options. It is one of the most important decisions you will ever make.
Michael Gilfix, Esq., is a partner at Gilflix & La Poll Associates in Palo Alto. For more information, call 493-8070 or email MG@Gilfix.com.