Costs of early to middle stage care

LuisGranadosDC

I am looking at purchasing some long term care coverage. One that I like starts benefits when I can't do two of the six activities of daily living (ADLs), like dressing, hygiene and eating. Others start benefits EITHER for that, or for having cognitive impairment.
I assume that there are circumstances in which I could have Alzheimer's (e.g., not remembering faces, words) but still be capable of doing at least five of the six ADLs, so the coverage I am interested in would not commence. My question is this: if I'm in that middle spot (serious cognitive problems and probably miserable and making others around me miserable, but can still do ADLs), how much MONEY does that cost the caregiver? I'm tempted to think that if I can still do dressing and hygiene, etc., the pure dollars cost of caring for me is not that high. Is that wrong? If so, where does the expense arise? Just in preventing me from wandering off? I'm interested only in home care expense here -- the coverage does cover nursing home costs.

Nowhere

Here’s one example in the Midwest - My husband’s assisted living memory care is a locked facility to prevent him from wandering. They manage and admin his medications, wash his clothes and linens, clean his room once a week, and prepare and serve meals. Cost $4500 per month. His ADLs are in place, except he can’t remember or executive function to have good hygiene. I take care of his personal hygiene needs as he’s nearby and comfortable with my assistance. He tells the aides, “No”, to their offers to assist. Depending on your age, be certain that your policy has an inflation rider, increasing the pay out amount annually by a calculated percentage. The policy I bought for myself can be paid out to aides caring for me in my own home (including my family) or be applied to a facility. At home care for dementia assistance 24/7 by visiting aides is oft more expensive than in a facility care.

I also should say he’s considered advanced Alzheimer’s. Some drop of the disease whilst able to still walk and talk and skip the prolonged lingering in a wheel chair or bed or required assistance with feeding. Two fellow residents matching this description passed this fall. Probably wise to buy a worst case scenario policy, though, for peace of mind (while you possess it). Sorry. 😣

It’s wise you’re thinking about this.

harshedbuzz

I am looking at purchasing some long term care coverage. One that I like starts benefits when I can't do two of the six activities of daily living (ADLs), like dressing, hygiene and eating. Others start benefits EITHER for that, or for having cognitive impairment.

For most family caregivers of PWD, the decision to bring in outside help is driven by issues of safety rather which will precede loss of the ADLs. Sometime by years.

I assume that there are circumstances in which I could have Alzheimer's (e.g., not remembering faces, words) but still be capable of doing at least five of the six ADLs, so the coverage I am interested in would not commence.

Alzheimer's and other forms of dementia are about so much more than the bolded. Early losses in executive function, reasoning skills, empathy and the potential for anosognosia will likely require supervision of IADLs well before a PWD needs assistance in toileting or bathing. And while each PWD will have their own distinct pattern of losses, my own father knew who mom and I were and was conversational up until he died from complications of aspiration pneumonia.

My question is this: if I'm in that middle spot (serious cognitive problems and probably miserable and making others around me miserable, but can still do ADLs), how much MONEY does that cost the caregiver? I'm tempted to think that if I can still do dressing and hygiene, etc., the pure dollars cost of caring for me is not that high.

Why would you think that? Would you dock a babysitter for the hour your child naps? Of course not because they are still doing their primary job which is safety.

Is that wrong? If so, where does the expense arise?

The shift is the shift. Unless you required a 2-person lift or skilled nursing, the aide will charge the going rate. Think of it as buying their time. You wouldn't pay an hourly cashier at a store less on a day when sales were slow.

Just in preventing me from wandering off?

Preventing you from wandering off? Yes. Perhaps accompanying you on your walk. Preventing you from cooking and starting a fire or sticking a fork in the toaster or taking your prescriptions a second or third time because you don't recall having them with breakfast. Often caregivers set up activities for their PWD because the person can no longer entertain themselves.

I'm interested only in home care expense here -- the coverage does cover nursing home costs.

We paid $32/hour 6 years ago for an agency aide in a MCOL area. The COL where you live will play into costs. The other piece is whether you live alone or have someone able to look out for you part of each day— say overnights and afterwork.

HB

Carl46

Cognitive impairment can happen to anyone at any time. Thats why every adult should have POA, financial and medical, set up. One bang to the head, in a car wreck or whatever, can cause permanent brain damage.

My LTC policy becomes effective when the beneficiary needs constant supervision or needs help with two ADLs such as eating or dressing. I bought LTC coverage so my wife wouldn't be impoverished if my income was required to keep me in a NH after a stroke or other catastrophe. I bought coverage for her as an afterthought. Ironically, she will be the one to use it, quite soon.

Victoriaredux

Here is a post about LTC coverage in case you missed it - it's a tough product to pencil out these days .

https://alzconnected.org/discussion/71071/article-on-long-term-care-insurance

LuisGranadosDC

Thanks to all who responded. Your comments are very helpful.

harshedbuzz

@LuisGranadosDC

There's another piece to caregiving that I didn't consider until I found myself in the thick of it. Because of the way in which my dad presented— agitated, paranoid, aggressive and unaware of the degree of his impairment (see "anosognosia")— the emotional weight of his anger at the limitations placed on him around driving, having his financial life taken over and no longer steering his own ship made mid-stage caregiving a special kind of hell even if he could dress and toilet himself. It was much harder than it was later.

HB

ElaineD

We bought our LTC policies 25 years ago. We had to have a physical exam, in our home, and a complete medical history was required. Failure to reveal a pre-existing condition for which we subsequently file a claim will invalidate our policy.

Our insurance company is UNUM and they no longer sell LTC policies.

The requirements re: ADL (activities of daily life) are very specific. Recently I thought I could activate my policy for both Bathing and Dressing. However, I only need help with dressing. I can undress myself. We still live in ouir Independent Living apartment, can I can have home health care aide to help with dressing and bathing, which would be less than an hour each morning. Help with undressing (which would qualify me) means the aide returning in the evening. I don't want and aide morning and night for seven days a week.

My husband currently helps me dress.

My husband has mid stage dementia by the way, and will not qualify for LTC unless he cannot be left alone and needs CONSTANt supervision.

IF we went the Assisted Living facility across the street, I would immediately qualify under our policy. My husband who still manages many activities, doesn't want to move with me to Assisted Living, of course. He wouldn't qualify for LTC even in Assisted Living. Who would want to go to assisted living unless they must!

I have severe progressive polyneuropathy and cannot walk at all. I'm in a power chair now.

Husband is 85 and I'm 82. He will need supervision in a year or two, and then we can move to assisted living (perhaps he'll need Memory Care).

Fortunately the cost of our LTC ($4,000/month for 6 years) for both of us is only $203/month.

Elaine

CampCarol

Whatever you decide, read the fine print very carefully. I picked up my policy in my early 30’s after watching my grandmother run out of money in a nursing home. DH has the same policy. What I’m learning now since I had to invoke it for him is that what we have is primarily facility coverage. They only cover $220/day for home care, which equates to about 6 hours of coverage here in the northeast. Facility coverage is ~$390/day. The MC quotes I’ve gotten to date all start at about $10K per month, so this policy will be a huge help for a few years should he end up moving there. There is a dollar cap on lifetime coverage, so I’m trying to be very frugal with outside care right now. I have an aide 2 afternoons per week. Also check if they have a waiting period before coverage will begin and what that criteria is. Lastly, as @Nowhere stated above, the inflation rider is critical, especially with what’s happening now with healthcare and the economy in general.