What exactly is nursing home preplanning and when do you need to start thinking about it? Ideally, nursing home preplanning happens about five years or more before you think you or a loved one will need long-term care. Many seniors are concerned about losing their home and other assets if they one day require nursing home care. The best approach to ensuring that the cost of long-term care doesn’t deplete your assets is advance planning.

Most people don’t have enough money saved for long-term care costs and Medicare doesn’t cover nursing home costs beyond a short-term stay. You may have too much money for government assistance — Medicaid — yet not enough money to afford quality nursing home care, and so you can preplan.

There are some legal strategies to re-categorize assets so you can qualify for Medicaid, but they require a lawyer’s assistance so that you don’t have to lose your assets in attempting to pay for long-term care. The benefit of preplanning — which usually involves putting assets in a trust — is you avoid the Medicaid five-year look-back period that examines asset transfers prior to the Medicaid application.

Pooled trusts can enhance quality of life by paying for services that Medicaid doesn’t cover. The sooner your estate plan incorporates the necessary elements of preplanning, the more effective your asset protection can be.

Choosing the right place

Once you have preplanned financially, you can go about choosing a desirable facility. Research the policies and programs of long-term care facilities. There’s no central clearinghouse that provides such information, but here is some starter data:

  • In general, assisted living facilities are state-licensed housing communities offering residents a range of services to help them with daily living. They don’t include the medical care found in a skilled nursing home, but they do provide meals, education and social activities as well as help with mobility, bathing, dressing and medication management.
  • Assisted living communities can be large or small. The smaller type are adult foster homes — residential houses for three or four residents, with paid caregivers.
  • A helpful all-in-one resources is A Place for Mom, which is a free senior care referral service paid for by partner communities. Other well-known referral services are:
    • Caring.com
    • OurParents.com
    • SeniorHomes.com
    • SeniorAdvisor.com

Sue Johansen, A Place for Mom’s vice president of partners services, says the best advice is to get real. The more candid individuals and families are about current health needs and potential issues, the better the odds that advisers will be able to come up with the best solutions. Evaluate the environment of long-term care facilities to see what the resident mix is, as well as how the staff interacts with the community. A good way to do this is to have a meal in the dining room.

Researching in advance is so much better than being in panic mode and having to find a spot immediately. If you have some planning time, decide which area of the country your loved ones want to be in and plan several visits.

Questions to consider and tips about how to engage when visiting:

  • How does the culture and atmosphere feel?
  • Is the facility clean? Does it smell?
  • Visit a few times at different times of day. My friend was in a facility for rehab. I commented on how wonderful it seemed to me. He responded: You should be here at night when the screaming starts.
  • Eat in the dining room a few times.
  • Talk to the people in charge.

Before deciding on a plan of action, discuss all your options with a lawyer so you can fully understand federal and state Medicaid laws and design a plan suited to you and your family.

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