Long-Term Care Pre-Planning Checklist: 10 Items to Consider

Updated

Certified Care Manager, Aging Life Care Professional, and National Master Guardian Emeritus

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It is impossible to plan your future down to the last pebble, but when it comes to long-term care, it is important to at least put some plans together. Everyone plans when there is something important we want to achieve. If you want to improve your health, learn something new, change your career, or move to another city or state, these all require planning.

Long-term care pre-planning is unique because you don’t know what your aging process will look like. And it can feel impossible to prepare for something that you don’t need right now. It is normal to imagine yourself aging without the need for help, but that scenario is rare. Almost everyone needs some help as they age. Knowing your options and the costs of those options will help you make wise choices as you age.

1. Advance Directives

Advance directives are the plans you make in case you are unable to speak for yourself. They also include directions on the kind of care and interventions you want in case you are near death.

If these plans are not in place when you need them, your family may not know what to do and may do something contrary to your wishes. 

Healthcare and financial proxy

Think about naming a trusted person to carry out your healthcare wishes, if you are unable to do so. Your healthcare proxy can also advocate for you with healthcare professionals. 

Also, consider naming someone to take over your finances if you are unable to do so.

End of life

It is hard to think about the end of your life before you need to. Making your wishes known now (and they can always be changed later) directs family and medical professionals on the kind of end of life care you do or do not want.

ยป MORE: Don't skip these commonly forgotten post loss tasks. Download our post loss checklist.

 

2. In-Home Care

In-home care can be a lifesaver for families who can’t provide care for a loved one themselves.

Professional caregivers offer a foundation of support that can allow people to recover and remain at home if that is what they wish to do. Surveys show that an increasing amount of people want to age in place.

Private duty

Private duty or personal care agencies have caregivers and certified nursing assistants (CNAs) to assist people of all ages with everything from cooking, showering, hygiene, to transportation and companionship.

Private duty is private pay except in certain circumstances such as Medicaid or long term care insurance coverage.

Medical home health

Medical home health is insurance covered, time-limited service for people who need short term rehabilitation at home. A home health team consists of nurses, physical, occupational, and speech therapists. Aides are also available for showers, transfers, and dressing.

3. Rehabilitation

Rehabilitation is a short stay in a community designed to help you recover from an accident or illness.

Rehabilitation is an accelerated system of therapies, nursing, and physician services to get you safely back home as soon as possible. Then, once you are home you can arrange for private duty and/or home health to get you to the finish line.

Finding a good one

  • We recommend finding your top three choices for rehab before you need it. That way you do not have to make the decision during a crisis. Your insurance may dictate where you can go so make sure your choices are covered by your insurance.
  • Ask your doctor if he or she has suggestions or contact a geriatric care manager who has had direct experience working with rehabilitation centers.  

4. Health Insurance

Health insurance is complicated and confusing. Just take a look at the insurance booklets that arrive yearly. They are huge. However, taking the time to understand your insurance will pay off in the long run.

Understand what insurance pays for

  • As with any insurance, health insurance has its criteria for and limitations of coverage. You don’t want to get stuck with an unexpected bill or find out that you are being discharged from rehab since your insurance stopped paying. Do what you can to try and understand what is covered and what is not, before you need it.
  • You may want to review your coverage yearly to see if there are better rates and coverage with a different company. A good insurance broker can help you make an informed decision.

5. Home Accessibility

You may be completely satisfied with the home where you live. But, imagine you break a hip or leg and your mobility is suddenly limited. This can happen at any age, but as people grow older home accessibility becomes more important.

Evaluate your home

Deferred maintenance can lead to much bigger problems later, especially during an illness or injury. One option is to have a home inspection done by a professional. That way you can tackle safety and structural problems before they get bigger.

Make modifications before you need them

Home modifications are a personal and financial decision. Not everyone is comfortable making changes to a home that may affect the value. There are, however, some simple changes to consider such as grab bars and a walk-in shower. Assess fall hazards and eliminate those to the extent that you can.

6. Housing Options

Most people don’t think about having to leave their home at some point, but sometimes it is the most prudent option. In-home care may have become too expensive or difficult to safely manage. Family caregiving may not be sufficient to meet someone’s needs. 

Assisted living

Depending on the number of choices you have, consider touring two or three communities to get an idea of their staffing and programming. Call your local Ombudsman program to ask about complaints.

When factoring in the cost of care in assisted living make sure you understand add on costs and yearly increases.

Cohousing or home-sharing

Cohousing or home-sharing are alternatives to assisted living. Cohousing can require a significant upfront investment but offers independence with a built-in community. Home sharing is gaining in popularity due to its affordability.  People rent out rooms or go in together to purchase a house. 

Memory care

Memory care communities are designed for people with dementia or other mental health problems. They are typically locked, secure communities with more one-on-one attention. Memory care communities may cost more than assisted living due to higher staffing requirements. 

7. Financial/Estate Planning

The success of long term care pre-planning is predicated on a financial plan that supports options. Knowing the limitations of yours or your family member’s funds will help guide you in your decision making. Some people plan for the most expensive option knowing that they may not need it, but if they do, they can afford it.

Financial advisor

If you aren’t comfortable assessing your estate, consider hiring a financial advisor to help you plan for the future. An estate planning attorney can help you set up a trust and/or financial power of attorney. 

Budgeting

A financial plan is only as good as the ability to follow a budget. You might have to account for care needs and costs to increase over time. If you are planning for a parent, having an honest and open discussion about finances is a good place to start. People can be very reluctant to talk about finances at first. 

If you don’t have a good understanding of your parent’s financial situation, it will be difficult to help them when they need it most. 

8. Nursing Home Care

Nursing home care is considered to be the last resort for most people. It is expensive, and sadly staffing can be inadequate. 

When it is needed

  • Nursing homes provide 24-hour nursing care for people who have complex medical needs that can’t be met elsewhere.
  • According to the Centers for Disease Control and Prevention, almost 50 percent of people in nursing homes have dementia. These folks may be too difficult to manage at home. 
  • Long-standing problems in nursing homes have been exposed by the COVID-19 pandemic. Containment of the virus in nursing homes has been very challenging.

How is it paid for

  • Nursing home care is paid for by three main sources: private pay, Medicaid, or long term care insurance. According to Genworth, a private room in a nursing home will cost about $102,000 a year. 

9. Identify Local Resources

Local resources are often overlooked in doing long term pre-planning. If finances are limited, local resources can provide a foundation of support.

Eldercare locator

Eldercare locator is the best one-stop-shop to find resources in your area. They have information on caregiver support, senior centers, insurance, transportation, and housing. 

Caregiver support

If you are a caregiver, you might need support. Perhaps as part of your planning process, build a foundation of support through caregiver blogs and forums. There is extensive Information on caregiving through AARP and the Family Caregiving Alliance.

Adult day care and other respite

Eldercare locator can assist you with finding respite opportunities for you as a caregiver, and your loved one. As with any resource, we recommend taking some time to make sure you find the right fit for your circumstances.

10. Technology

Technological advances for older and disabled adults are growing every day. People are often unable to access medical services or manage their own medications, but that’s where technology steps in.

Telemedicine

Due to COVID-19, seniors are accessing their health care providers through telemedicine services. It can take some time to learn the process, but this may be the wave of the future so that older adults don’t have to leave to see their doctors.

The internet

With some help, isolated seniors can be taught to connect with friends and family through social media or video conferencing.

Emergency response systems (ERS)

Emergency response systems continue to improve, with GPS location services and sophisticated fall alerts.

Long Term Pre-Planning For A Secure Future

Any long-term plan should be revisited every year to make adjustments or changes based on your goals or your financial situation. Taking the time to plan will give you peace of mind, and the confidence to make decisions about your future.

If you're looking for more on long-term care planning, read our guide on how to plan for old age and being childless.


Sources

  1. “Alzheimer’s Disease.” Centers for Disease Control and Prevention. www.cdc.gov/nchs/fastats/alzheimers.htm
  2. “Costs of Care: Trends and Insights.” Genworth. www.genworth.com/aging-and-you/finances/cost-of-care/cost-of-care-trends-and-insights.html 

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