For Clients, Advisors and Community
In my 32 years of practice, I have watched my clients age, enjoying long
years with their children and grandchildren. In our senior care (elder
law) practice, I am increasingly counselling my clients about long term
care issues including, the transition from independent living to getting
assistance whether it be with medications, getting to and from their doctor
appointments, daily errands and the activities of daily living (including
dressing, toileting, eating and other basic daily activities). Recently,
I have experienced this dilemma in my own family.
In the 1990’s, assisted living facilities came into vogue on a stand
alone basis or, more often, as part of more comprehensive long term care
communities (including perhaps acute and skilled nursing care facilities).
In an assisted living facility, each individual (or couple) has his or
her (or their) own small apartment and typically takes meals in a community
dining room or can make small meals themselves. There is 24 hour supervision,
medication assistance, daily activities, a shuttle bus to and from local
shopping and often other services available on an a la carte basis. The
2011 MetLife Market Study revealed that the average cost of assisted living
in Illinois is $3,490 per month.
Many people think that assisted living care is covered by Medicare. Generally,
it is not. Expenses for long-term care (caregivers, medication management
and the like) for individuals that are living in the community (not in
a hospital or in a nursing home) are not covered by health insurance programs.
Individuals who have purchased long term care insurance and who need help
with two or more ADLs (activities of daily living described above) may
qualify for benefits if they need to live in an assisted living residence
for that reason.
A recent Wall Street Journal article describes many families who have been
frustrated by the care for their loved ones received in an assisted living
facility. They describe a low ratio of caregivers to residents and long
response times when they need help. (In my experience, there are a few
really good facilities in the Chicago metropolitan area that offer services
from people who care. Nonetheless, I have heard the complaints of my clients’
loved ones about uncaring personnel, attitudes bordering on abusive behavior
on the part of the staff, bad food and occasionally, medication mistakes
at some facilities.)
The WSJ article describes some families who have started to look for long
term care solutions offshore. For the same cost of a small apartment,
some families have been able to secure a luxury residence in Costa Rica
shared by three patients including a nurse, three staff members and a
chauffeur. There was a community of U.S. citizens, they were able to go
to church every Sunday and have a full life there. The family reports
that they paid about the same cost as assisted living here, including
the cost of childrens’ travel back and forth to visit the parents
regularly. It’s certainly an “out of the box” solution.
As we baby boomers, and our parents, age, we will need to develop creative
solutions to keep us happy as we live longer. Here’s one alternative.