An Often Overlooked Area of Retirement Security: Long-term Care

1. An Often Overlooked Area of Retirement Security: Long-term Care Senior Citizens' Resource Center David DeBiasi, RN Alexandria, Virginia Associate State Director May 8, 2013 AARP Virginia

2. Which Costs More? • One year of nursing home care 1 year’s tuition, fees, room and board at a public university

3. The Answer: • 1 year in a nursing home • Private room • National average • $84,000 • Source: GenworthFinancial 2013 • 1 year’s tuition & fees • Room and board • Public 4-year university • National average $17,860 Source: College Board 2012

4. What Are Costs in Virginia? Homemaker $17 hour Home Health Aide $18 hour Adult Day Health Programs $60 day Assisted Living$45,300 annual Nursing Home (private room) $83,950 annual

5. Will you need long-term care? Contributing factors: Age Gender Health Status Family History Disability

6. Most People Will Need Some Care More than 2/3 of people once age 65 will 3 years is about average Women are more likely to need care (80% of women and 60% of men) for a longer period of time (3.7 for women and 2.2 for men) Older women are more likely to be living alone making any needed daily care more challenging.

7. More than a Nursing Home Changes to your home Technology that helps you stay independent Help with housekeeping, meals, and personal care like bathing or getting dressed Care provided by a nurse or other health care professional

8. Who Pays? Which of these is not a source to pay for daily long-term care that lasts well over 3 months? A. Long-term Care Insurance B. Personal savings and investments C. Medicare D. Medicaid

9. Answer: C. Medicare Medicare was not designed to cover long term care in any setting. It does pay for: • part-time, intermittent home health care. • some short term nursing home care following hospitalization. Most daily long-term care consists of help with daily activities like dressing, bathing or eating. Medicare is not designed to cover this.

10. When Medicare pays for nursing home • Your doctor orders “skilled nursing” or rehabilitation, such as physical, occupational, or speech therapy. • You have been admitted to the hospital at least 3 days for a related condition. • You are admitted to a Medicare-certified nursing home generally within 30 days of the hospitalization. • Medicare pays 100% for days 1-20, you pay co-pays for days 21-100, after 100 days you pay all costs. *Medicare coverage for home health care also has restrictions.

11. How Do People Pay for Long-term Care? Most people use a combination of resources, most often unpaid help from family and friends. Personal resources (savings, investments, home) Medicaid (largest payer of nursing home care in the U.S.) Public and voluntary programs and services Long-term care insurance

12. Unpaid Help from Family • Unpaid care provided to older relatives or friends in the U.S. = $450 billion • In VA, roughly 1.8 million unpaid caregivers provided nearly $11.7 billion in care in 2009.

13. When Unpaid Help Is Not Enough Most people do not own long-term care insurance. People generally must pay out of pocket. Once resources are used up, people rely on Medicaid. Most people (85%) prefer to receive care at home. With budget pressures, services that help you stay in your home are at risk.

14. Does Your State or CommunityOffer Any Types of Assistance? Use the Eldercare Locator to find out about services. Go to www.eldercare.gov or call 800-677-1116. Explore state and local programs: Some programs are in most communities, while others are unique to an area or state Different eligibility rules (such as age, income, level of disability, or any combination)

15. More Options for Paying Some of the Costs of Long-term Care Department of Veterans Affairs (VA) Local housing authority Faith-based programs Health- or disease-based programs

17. Financial Resources for Accessibility Improvements Livable Homes Tax Credit The Livable Homes Tax Credit provides a $5,000 state tax credit for the purchase of a new residence with accessible features and up to 50% of the cost of retrofitting an existing home, not to exceed $5,000. www.dhcd.virginia.gov/lhtc 804-371-7124 Accessibility Rehabilitation Forgivable Loan The Federal Home Loan Bank of Atlanta provides up to $12,000 to pay for accessibility improvements of an existing owner-occupied home. Eligible improvements include exterior ramps and sidewalks, bathroom and kitchen renovations, door widening, floor replacement, and more. Loan is available to borrowers earning 80% or less of the area median income. www.fhlbatl.com/docs/cis/ahp-setaside-brochure.pdf

18. Other Resources for Accessibility Improvements Accessibility Grant for Rental Units Up to $2,000 per rental unit for accessibility improvements is available to tenants with disabilities who earn 80% or less of the area median income. www.vhda.com/Renters/Pages/AccessibleRentalHousing.aspx 1-804-782-1986 Rebuilding Together With a dedicated team of volunteers, Rebuilding Together repairs and rehabilitates homes free of cost for those in need, including the elderly, persons with disabilities, military veterans, and families with children. www.rebuildingtogether.org

19. Free AARP Online Resources • Tools, tips from experts and information on important topics for caregivers: www.aarp.org/caregiving

20. Thank you and please stay in touch with AARP Virginia!AARP Virginia State Office 707 East Main Street, Suite 910 Richmond, VA 23219   Toll-free: 1-866-542-8164  Fax:  804-819-1923email: vaaarp@aarp.orgwww.facebook.com/AARPVirginia

21. David M. DeBiasi ddebiasi@aarp.org