An Important Question For Your Clients Contemplating Retirement

An Important Question For Your Clients Contemplating Retirement

Jun 18, 2019 | aging, aging investor, cost of aging, cost of long term care, declining health, elder investor, elderly, finances for elders, financial advisors, financial judgement, long term care, nursing home, resources for senior, resources for seniors, retirement, retirement planning, senior investor, seniors finances

An Important Question For Your Clients Contemplating Retirement

Longevity is increasing, as millions of Americans are living to 90 years and above, the U.S. Census Bureau reports. Will any of these long-lived folks be the parents of your current clients? Some clients reaching retirement age themselves will be dealing with the challenges of their aging family members, even as they plan their own retirement years.

One critical question perhaps not built into your calculations for retirement income needs should be whether your clients can reasonably expect to have to support their aging parents. As reported by NPR citing the Census Bureau report, nearly 20 percent of 90- to 94-year-olds live in nursing homes. Among those 95-99, about 31 percent are in nursing homes. And in the 100+ population, 38.2 percent live in nursing homes. Who pays for that care?

Most financial advisors have a basic understanding that Medicare benefits are very limited when it comes to nursing home care. Post hospitalization, the maximum benefit is 100 days and most people do not receive even that, due to qualification requirements. For those who have to live in nursing homes long term, rather than for shorter stays involving rehabilitation such as physical therapy, the costs are paid out of pocket. The exception is for the lowest income elders. For them, Medicaid pays the cost of long term nursing home care. For everyone else, a long stay in a nursing home can wipe out an older person’s assets. The financial burden then falls on family who may have the means to prevent the impoverishment of their loved one.

Some adult children will not allow Mom or Dad to live in a nursing home long term. Maybe it was a promise they made to the aging parent. Essentially, it is no one’s first choice of where to go when care is needed. If a family has some assets but does not want to wipe out their own retirement income by paying for nursing home care or even full-time home care, the most cost effective solution is to take in the aging parent.

There is a cost involved in this choice as well, and it extends to many factors beyond money. Every family relationship in the household is impacted. Some adult children are not patient, not willing and not good at caring for an impaired aging parent in declining health. For others it is seen as an honor and a final chance to give back to the parent in gratitude for what the parent did for them over a long lifetime. Individuals vary in their perspectives, ability and willingness to take in an aging loved one.

Some families take in an aging parent and pay for part-time help, providing a significant part of the caregiving themselves. Others pay for assisted living for an aging parent, but that is not suitable for those who need care around the clock. Others allow a parent to spend down their assets until they can qualify for state paid nursing home care. The parent is then placed there somewhat as a last resort.

No matter what choice a client will make about an aging parent, it is important that the financial professional in their lives helps them see the big picture and plan according to anticipated needs for both the client and the elders for whom they feel responsible.

The Takeaways

  1. Longevity is creating an issue for families who are facing years of decline in aging parents who may not have the means to pay for care on their own.
  2. Responsible financial advisors must raise the question with every retiring client: is there someone in your life that you will likely have to support financially during your retirement?
  3. Advisors and families alike must consider and plan for how any essential financial support should be handled by adult children of aging parents. Take in the parent? Supplement the parent’s income by paying for home care or assisted living?
  4. When the means are not available to offer financial support, and the physical needs for care are extensive, it sometimes becomes necessary to allow the aging parent to become impoverished and to qualify for Medicaid. Medicaid does pay for long term nursing home care.
  5. For those with sufficient investment income expected, financial support for aging parents can be part of an overall retirement planning strategy. It is up to the financial professional to help with this process.

 

Carolyn L. Rosenblatt, RN, Attorney, AgingInvestor.com ©AgingInvestor.com™

 If you the financial professional need a clear explanation of the actual costs of long term care, whether at home, in adult day centers, assisted living or skilled nursing, get the facts so you can plan with clients. It’s all laid out for you in Hidden Truths About Retirement & Long Term Care, available now. Click here to get your print, digital, or audio copy.

About Carolyn Rosenblatt and Dr. Mikol Davis

Carolyn Rosenblatt and Dr. Mikol Davis are co-authors of The Family Guide to Aging Parents (www.agingparents.com) and Succeed With Senior Clients: A Financial Advisors Guide To Best Practices. Rosenblatt, a registered nurse and elder law attorney, has more than 45 years combined experience in her professions. She has been quoted in the New York Times, Wall Street Journal, Money magazine and many other publications. Davis, a clinical psychologist and gerontologist, has more than 44 years experience as a mental health provider. In addition to serving his patients, Davis creates online courses and products to assist professionals and the public with understanding aging issues. Rosenblatt and Davis have been married for 34 years.

One Thing Advisors Should Never Do In Retirement Planning

One Thing Advisors Should Never Do In Retirement Planning

Mar 6, 2017 | aging, elderly, long term care

I recently saw an article about retirement planning, describing that one should consider where nursing home care is the most affordable and think about moving there. As if it were in the category of nicest cities to retire in or best recreational opportunities. I am appalled when I see these comments. For openers, no one I've ever met would choose a nursing home for long-term care if any other possible option were available. If a client can afford any other arrangement, try planning for that. Consider home care, adult day services, home health agencies and whatever long term care insurance can cover. Never tell them to plan for a nursing home.

There are of course good, well-run nursing homes where long-term care is delivered competently and with skill. Unfortunately there are a lot of other nursing homes where the opposite is true. In my opinion as one who has worked in them as an aide and an RN and who has sued a few as a lawyer, I can only urge caution. They can be dangerous places.

In our society, we do not have special nursing homes for elders who were, at an earlier time in life, convicted of serious crimes. We do not have special nursing homes for those who suffer from mental illness. If the resident does not have mental symptoms serious enough to be placed in a mental hospital, particularly if skilled nursing care is needed for physical conditions, the mentally ill elderly are in the same place as your Grandma, your client or anyone else. Many people with dementia are also cared for in nursing homes. Some have separate units for dementia care but others do not. There are behavior issues with these residents that can and do affect other residents.

Nursing homes are referred to as "skilled nursing facilities" (SNFs), long-term care facilities, rehab facilities and care homes. No matter what you call them, good care can happen and danger may lurk as well in any of them.

Planning for long term care is an essential part of planning for retirement. Nearly 70% of us are going to need that care at some point. If your client needs full time 24/7 care in the future, plan for the possibility of paying for it at home. Many aspects of care, including skilled care can be delivered through licensed home health agencies. Planning for a last resort that is risky does not seem the best way to plan for one's later years.

Here are three reasons why you should avoid telling your client to live where there are affordable nursing homes. That assumes that your client would have to accept living in one.

  1. Abuse from other residents

A recent study of New York nursing homes conducted over one month found that, conservatively, one in five nursing home residents are the victims of abuse by other residents. Rates of abuse were significantly higher when nurse aides have a higher numbers of residents to care for and in dementia units. Most of the abuse was verbal, but some involved hitting (11.3%) or pushing (10.3%) and a smaller percent that were sexual.

  1. Overuse of antipsychotic drugs

The Independent Drug Information Service reports that antipsychotic medications are often overused in older patients in nursing homes, and they increase risk of death and can cause substantial side effects.

  1. Risk of eviction if a client outlives her assets

An expert in the field is Pat McGinnis, Executive Director of California Advocates for Nursing Home Reform. She sees long term care residents who are out of money being tossed out of some homes in favor of residents who can pay the high cost of living there. She stated “there is an epidemic of illegal and unsafe evictions from nursing homes throughout the state and this (referring to an eviction case) is perhaps the worst case I have ever seen. Nursing homes increasingly focus on higher paying therapy residents at the expense of poorer long-term or 'custodial' residents. When residents threaten this profit-making model, they all too often are thrown out illegally.”

There is no question that the complexity of some medical conditions and the need for skilled nursing around the clock makes it necessary for some older folks to live in nursing homes. Every person who plans to retire and is realistically looking ahead must recognize that she may need help one day and that help might get very expensive.

Any professional discussing retirement assets, spending, budgeting and how to stretch a client's money over many years of retirement should include the discussion about the last years and the cost of care. I am an advocate for using every conceivable alternative to nursing homes for planning purposes. Although a few are innovative and patient-centered, too many look and feel like a hospital, not a place to stay long term. Do your best planning to keep your clients at home with long-term care in place.

by Carolyn Rosenblatt, RN, Elder Law Attorney, & Dr. Mikol Davis, Gerontologist co-founders AgingInvestor.com