How should I finance assisted living?

In March 2018, the U.S. Census Bureau reported that by 2030, all baby boomers will be over the age of 65, leading to a unique situation in demographics: 20 percent of U.S. residents will be retirement age.

This is in part because life expectancy has increased. The Population Reference Bureau reports that “average U.S. life expectancy increased from 68 years in 1950 to 79 years in 2013, in large part due to the reduction in mortality at older ages.”

As health care has improved and life expectancies have extended, more people are living longer after they would traditionally have stopped working. This has led to a potential crisis for many Americans: how to pay for the typically increased amount of health care and assistance needed as the years march onward. It’s like an absurdist word problem in sixth grade math class: If you retire at 65 and need to enter an assisted living facility 10 years later, how much money will you need to pay for the impossible-to-predict level of potentially very expensive health care you’ll need over what could be a similarly hard-to-estimate 10- to 30-year or longer timeline?

These are critical questions that all older adults need to consider because most facilities rely primarily on private payment, and Medicare does not cover the cost of assisted living facilities, says Roxanne Sorensen, an Aging Life Care specialist and owner of Elder Care Solutions of WNY in Rochester, New York, a case management consultancy. “Medicare does not pay for any form of assisted living. It only pays for rehab in a nursing home for the first 100 days. After that, there’s no more assistance from the government unless you’re on Medicaid,” and Medicaid only kicks in once someone has spent down all of their assets and is essentially destitute. “People today are using their income and whatever assets they might have” to pay for assisted living when they need it.

[See: How to Pick a Health Insurance Plan.]

It can be a tall order. According to a 2017 survey conducted by Genworth Financial, the median monthly cost for an assisted living community is $3,750 — totaling $45,000 annually. Long-term care by a home health aide tops $4,099 monthly or nearly $50,000 annually. And skilled nursing in a private room will set you back $8,121 per month, adding up to more than $97,000 per year.

These high costs are “all the more reason that we don’t only need to save for retirement, but we need to also save for the possibility of needing assisted living” in retirement, says Scott Tucker, president and founder of Scott Tucker Solutions, Inc., a Chicago-based financial planning company that specializes in helping clients plan for retirement. Saving early and often should form the foundation of your plan. “The key really is the stuff my grandpa told me. He was a World War II veteran. Folks like him who lived through the Depression; they always tried to save as much as they could and spend as little as they could.”

But for whatever reason, that lesson didn’t translate so well from the so-called greatest generation to their baby boomer children. “Generally, in the U.S., we see baby boomers and the younger generations not saving enough. The culture has changed and people are not saving enough,” so by the time they start thinking about retirement, often in their 50s or 60s, “there’s nothing to work with,” and the fear is, it might be too little too late by then.

It’s a tough topic to tackle, especially when so many of us are struggling to make ends meet today, much less think about what’s going to happen 40 years down the line. “What everyone wants to do is put this off until the kids are out of college, or until after Thanksgiving, or after we retire next year,” Tucker says, but this important planning needs to happen “much earlier, and folks are not realizing that.” Making plans at age 40 versus age 70 can make an enormous difference, Tucker says, noting that the younger you are when you start, the smaller the effort you’ll have to make to add up to enough savings later on. “Making some small changes younger makes this whole thing a lot easier.”

No matter when you start, there are a variety of ways to plan for retirement and finance assisted living, and finding an advocate or planner to help you navigate this complex world might be a great option for many families, Sorensen says. “It’s really complicated,” she says, but her business and many others like it across the country can help families navigate the complex questions of which facility to enter, how to pay for it and all the other complicated issues that can arise alongside these challenging questions. Sorensen and other case managers and advocates like her have extensive experience and understanding of this fractured system and relationships with assisted living facilities, meaning that they may be able to cut through some of the complexity much faster than the average person.

The bottom line is, “money is the key to everything. I hate to say it that way, because medical care and compassion are a part of it, but it’s lower on the totem pole,” she says of the problem of financing assisted living in America. It seems that if you have the money, you can buy those things. But it all starts with enough money to get you into an appropriate care situation.

There are a number of strategies you can use to fund assisted living and other long-term care options, including some of the most common ones outlined here:

Long-Term Care Insurance

Similar to health insurance, long-term care insurance ostensibly exists to cover you in the event that you need care in retirement. These policies are intended to cover your long-term health care needs. It may come into play for at-home care, an assisted living community or other long-term care facilities. Such policies can be a good option, but Tucker says this probably shouldn’t be your primary choice for funding assisted living because “the way these policies are constructed, they allow the company to change the premiums as you get older or to reduce the benefits if you can’t afford the higher premiums. It doesn’t always work out” the way you might expect it to.

Sorensen adds that there can be other challenges associated with accessing the benefits of these policies. “It’s like your car insurance or homeowner’s policy. You pay for them, but [the insurance companies] don’t want you to take advantage of them. They’re trying to find ways of not letting you use the benefits, so you have to jump through a lot of hoops to trigger that policy.” However, once they have been triggered, they may provide a good source of funding for your needs. Read the fine print and be sure you know what you’re buying if you purchase such a policy.

[Read: Aging Parents at a Distance Who Aren’t Really ‘Just Fine’.]

Life Insurance

Many life insurance policies include a provision for long-term care benefits. Tucker says these can be a good option for financing assisted living because these long-term care benefits are less changeable than those typically found in long-term care insurance policies, making them a potentially more stable option. Again, read the fine print and be sure you understand the terms of any agreement you sign. Also be sure to pay the policy as stipulated in the contract. “If you forget to pay the premium, they’ll cancel your policy,” Sorensen says, and then that money you invested in the plan will be lost.

Pensions, Annuities and Investments

If you’re lucky enough to have a pension, that’s a good way to help pay for care in an assisted living facility. Similarly, if you contributed to a 401K plan, an IRA or another investment product while you were working, that money will hopefully be there for you when you need it. “A lot of folks come to us, and if they don’t have a pension, they might need a fixed annuity to act like a pension,” Tucker says. Annuities are financial products that pay the owner on a regular basis and, in some cases, they can be structured to essentially replace the paycheck you used to receive from your job.

However, the Great Recession put a large dent in many people’s retirement savings, and that could lead to an even bigger problem down the road, Sorensen says, “A lot of the boomers don’t have the investments. They got wiped out and they don’t have the pensions. So, my prediction is that assisted living facilities are going to have to look at offering alternatives and reduced rates,” so that seniors can stay in the community they’re in even after their money has all been spent. Until such time as big changes to this sector arrive, stay on top of any retirement plans or investments you may have so you know whether your nest egg is growing or shrinking.

Veteran’s Benefits

For people who served in the military and meet the criteria of the program, Veterans Aid & Attendance and Housebound benefits can be a great option to pay for assisted living in retirement. Sorensen says these benefits can be significant (about $1,700 per month for the veteran and $1,100 for a widowed spouse). This federal money sometimes helps her clients “stretch what their investments or savings can do. Maybe that $1,700 bought them a year or two instead of having to utilize all their checking, savings and those annuities. I always try to tap into the VA system if possible, as that’s a really great way of putting someone into assisted living or assisting with nursing home placement,” she says. Given that it’s impossible to know how long you’ll live or how much money you’ll need, it’s important to maximize the money you’ve saved so that you can access high-quality care for as long as possible.

Leveraging Your Home

If you own a home, that property can be a very large asset that may well offer you the means to pay for care in retirement should you need it. “If you had some home equity, even if your spouse dies and you’re planning to remain in the home, you could take out a reverse mortgage,” Tucker says. With a reverse mortgage, you sell your home back to the bank a piece at a time while you continue to live there, so you get a monthly check, “freeing up tax-free money without creating additional payments,” for yourself as might happen with an insurance policy you’re paying into.

You can also sell your home outright and downsize. “If you’re the last surviving spouse and the kids don’t want the house, you could sell the house to pay for assisted living. You can even take a short-term loan or bridge loan from the [assisted living] facility [you’ll be entering] while the house is sold,” if you need to get into a facility in a hurry after a medical event, for example, Tucker says.

If you’re on a longer time horizon of needing care, you might consider simply downsizing and banking or investing the profits. Many older adults sell the home where they raised their children and move into a smaller and less expensive-to-maintain condo or retirement community, and then use the proceeds to bolster savings for whatever their health care needs may be down the line or to enter an assisted living facility when the time comes.

[Read: Finding Support for Seniors Facing Challenges Living Alone.]

Find Qualified Help

To help you sort through all of the variables and navigate what can be a complicated and sometimes emotionally fraught process, you might want to seek the help of a financial planner or advocate who’s well versed in issues of paying for assisted living and long-term care. Particularly for members of the sandwich generation who are having to help their aging parents navigate these challenging questions, dealing with the future is something that should happen now and with qualified help. “Families are making some of the most important decisions of their life while they’re emotional,” Sorensen says. “They don’t have time to think about it. They’re in a crisis situation and now they have to decide where mom or dad is going to be institutionalized for the rest of their life.”

For this reason, she says it’s critical to do some pre-planning before you hit that crisis moment when a loved one has, for example, had a stroke and suddenly needs a lot more assistance than he or she once did. “The best advice I can give anybody is to pre-plan. It does not hurt to sit down and have a conversation with your parents,” and discuss what could happen and how you’ll handle various situations. “At least have a plan and find out what their wishes are.”

In addition to talking about what your loved one would prefer, Sorensen says you need to discuss “the facts. What is their income? What investments do they have?” If your loved one is hesitant to share the details of their financial situation, it’s important to find out at a minimum the type of accounts they have and who to contact if they are incapacitated. After a medical crisis, Sorensen says “most families come into a house and don’t even know where to look,” for the paperwork that will explain a loved one’s investments and their life insurance.

The bottom line, she says, is to put together the beginnings of a plan as early as possible. “Step one: Get power of attorney and a health care proxy in place. Step two: Do the pre-planning. You may not need to put the plan in place for five or 10 years, but at least you have a starting point.”

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How Should I Finance Assisted Living? originally appeared on usnews.com