Planning for long-term care either for you or a family member is a task most of us are reluctant to consider. Long-term care may be needed at any age, but the possibility of an individual requiring some form of long-term care increases as we age. It is very important to make decisions regarding long-term care in advance of your need.

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for
Long-term Care
Cheryl K. David
Estate Planning and Elder Law Attorney
Law Offices of Cheryl David

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PLANNING FOR LONG-TERM CARE
Planning for long-term care either for you or a family member is a task most of us are
reluctant to consider. Long-term care may be needed at any age, but the possibility of an
individual requiring some form of long-term care increases as
we age. Those of us over age 65 have a 70% chance of needing
long term care in our lifetimes. One in three will receive some
form of residential care in an assisted living center or nursing
home.
Long-term care is needed when we are no longer able to
perform activities of daily living, such as bathing, transporting
and eating. We may also require assistance with what are
considered instrumental activities of daily living, which include
preparing and cleaning up after meals, housework, paying bills,
caring for pets and remembering to take daily medicines.
Thankfully, not every family needs long-term care, but given our longer life spans, many
will have this need. Your choice of facility is an important consideration, and should be
thought out well in advance of the day when you or a loved one enters the doors.
It is very important to make decisions regarding long-term care in advance of your need.
First, you need to make decisions at a time when you are physically and mentally capable
of doing so.
Given the importance of your care choices, it is best not to make choices under the
pressures of a strict deadline. Equally important is the effect that stress can have on your
body. Your recovery and rehabilitation will progress more quickly if you are not facing
the tasks of planning your care when you have an urgent need.
Long-term care may
be needed at any
age, but the
possibility of an
individual requiring
some form of long-
term care increases
as we age.

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WHAT FACTORS SHOULD I CONSIDER WHEN CHOOSING A LONG
TERM CARE FACILITY?
The quality of care is clearly a very important consideration so you should do your
research. Ratio of patients to staff is usually recommended to be six or eight to one. Also,
the skill level of the staff is important as there should be some RN’s on staff in addition to
medical assistants.
You may wish to visit any centers you are interested in several times, at varying times of
day, to note any differences in the level of care available. If you are able to make
unannounced visits, take advantage of that opportunity.

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One of the things many people focus on is location. This is only natural, as we want to be
near our family and friends. Many people also give great consideration to the physical
layout of the building.
Well-lighted, bright areas and wide doorways and halls are important, visually and from a
safety perspective. Views of woods, mountains or water also contribute to the physical
charm of the facility
WHAT ARE THE COSTS OF LONG TERM CARE?
Costs vary according to the services rendered and
your location. If you need someone to come to your
home, current costs in North Carolina for
housekeepers and home health aides are averaging
$17 and $18 per hour respectively. Services
available at adult day centers are currently
estimated at $47 per day.
Those requiring residential care are looking at rates
of $3397 monthly for assisted living centers.
Nursing home care is averaging $182 daily for semi
private rooms and $204 for private
accommodations. Keep in mind that prices may be higher in the Charlotte and
Raleigh/Durham areas than the Piedmont Triad.
These costs may not include all of your costs as some facilities may charge for additional
services.
WON’T MEDICARE AND MY PRIVATE INSURANCE COVER THE COSTS
OF LONG-TERM CARE?
Medicare and most private health insurances will pay little or none of the costs associated
with long term care. They are concerned with costs of doctors and hospitals and will
Medicare and most private
health insurances will pay little
or none of the costs associated
with long term care. They are
concerned with costs of doctors
and hospitals and will exclude
most services.

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exclude most services. It is always
advisable to carefully review your
existing policies. If you have
purchased long-term care insurance,
these policies must also be looked over
carefully. Most will cover room and
board, but only at approved facilities.
You will in most cases have to pay
most of the costs of long-term care out
of your pocket. This will be in addition
to maintaining your current household budget.
WHAT ABOUT MEDICAID?
Medicaid may indeed help with your long-term care. To qualify, you must meet income
and asset limits, and in addition, there are asset transfer requirements. In some cases, the
state may place a lien on your estate to recover their costs. State requirements are subject
to change, and you can get some answers from your county Department of Social
Services. Additionally, and oftentimes preferably, you may want to seek legal council of
an experienced Elder Law and Medicaid attorney. There are many strategies that can be
employed to help you qualify for Medicaid while still preserving your assets, including
your home and life savings.
Income and asset limits are relatively straightforward. Your income is what it is. Also
your primary residence, your car and your personal possessions are generally exempt
from the asset test. Beyond this, state regulations are often as complex as any tax code
ever written.
When and how you have disposed of assets may also affect your eligibility. Current
regulations allow a look-back period of five years for disposal of assets. This has
increased from a traditional period of three years.

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You will most likely have to pay some of your income toward your care. In North
Carolina, this is referred to as monthly patient liability. Other states may use terms such
as share of cost or meeting your spend down.
CONCLUSION
Given the complexities of the Medicaid program, many people seek the help of an elder
law attorney when making plans for long-term care. These highly focused professionals
will meet with you to discuss your needs and your current financial status. They are in the
best position to confidentially advise you in this constantly changing environment. Their
experience and expertise will help you chart the best course given your unique situation.
REFERENCES
http://www.longtermcare.gov/LTC/Main_Site/index.aspx
http://www.medicare.gov/
http://www.ncdhhs.gov/dma/medicaid/

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About the Author
ABOUT THE AUTHOR
Cheryl David is a graduate of UNC-Chapel Hill, the University of Baltimore
School of Law, and the prestigious Trial Lawyer’s College presided over by
Gerry Spence. A former Administrative Judge, Cheryl is certified as an
Estate Planning Law Specialist by the ABA accredited Estate Law
Specialists Board, Inc. She is also a member of the American Academy of
Estate Planning Attorneys, Medicaid Practice Systems and the National
Academy of Elder Law Attorneys.
In 2008, Cheryl received the honor of becoming a Fellow with the
American Academy of Estate Planning Attorneys. The Fellow program
recognizes Academy Members who demonstrate advanced expertise and
significant practical experience in the total estate planning, trust, tax
planning, guardianship, probate and estate administration fields. In order
to maintain this advanced expertise, Cheryl takes over 36 hours of
continuing education in Estate Planning, Elder Law, and Taxation each
year. Also a Financial Planner, she holds the Series 7 and 66 Investment
Licenses in addition to both Insurance and Long Term Care/Medicare
designations.
Her professional capabilities, together with over 25 years in practice, have
combined to bring positive change to the lives of over 4500 clients and
their families.
528 College Road
Greensboro, NC 27410
Phone: (336) 547-9999
Fax: (336) 547-9477
WWW.CHERYLDAVID.COM