Part 4: Objections To LTCC's
By CarePatrol of Northern DE & South Chester County
The Basics of LTCCs
There are different types of LTCCs for different care needs. Every state has different regulations for each type of license but they are similar enough to look at the basics. The main options are generally referred to as:
- Independent Living (IL)
- Personal Care Home (PCH) / Assisted Living (AL) / Memory Care (MC)
- Skilled Nursing Facility (SNF) [Nursing Home]
You'll note that MC is lumped in with PCHs and ALs. Memory Care is a specific type of Assisted Living for those with significant cognitive decline and a diagnosed type of dementia like Alzheimer's Disease. Special activities and training are geared specifically towards those conditions.
The dividing lines between the different licensing levels of care communities tend to revolve around three things:
- Level of skilled medical capabilities
- Personal care support as measured through assistance with ADLs
- How the LTCC can be paid for - private pay, LTC insurance, Medicaid, VA benefits, etc.
Medical needs require skilled medical professionals like RNs and med techs. Help with ADLs is handled by lower level support staff trained to help with ADLs, which include ambulating, bathing, grooming, dressing, toileting and feeding (personal care support). Unsurprisingly, the more medical care and personal assistance an individual requires, the more expensive long term care becomes.
Independent Living is not licensed to handle high level needs, whether for medical or personal assistance, so they are naturally less expensive. Assisted Living can handle both but there are limits (feeding tubes, ventilators, etc.). AL communities usually utilize "Levels of Care" tiers that will, in part, determine what the cost is.
As a LTCC solution, Skilled Nursing (i.e. nursing homes) tend to be prohibitively expensive at $9k - $15k per month. As such, they are generally the last resort and are often paid for through Medicaid but that is only if and when the resident qualifies. Proper estate planning with a good elder law attorney can be the difference between qualifying for Medicaid or paying for long term care in a SNF out of pocket.
With that very brief introduction to different LTCC options (plenty more to come in the next two articles), let's take a look at some of the objections that seniors typically raise to moving into a LTCC.
Objections to LTCCs
It is not at all unusual for seniors to have very strong objections to moving into a LTCC. The reasons may vary but the resistance is strong and can be a huge challenge to overcome. There are 3 primary areas of resistance.
Loss of Independence
The first objection to moving to a LTCC is often loss of “independence”, whether real or perceived. Moving to a LTC community is, to many, a concession to the sands of time and many people have a primal resistance to that concept. This is often the toughest to overcome since it is a psychological hurdle, one that often remains unbroken by heartfelt appeals to common sense, logic or hard facts. Overcoming this obstacle is often a process that involves time and, unfortunately, an ‘event’. My own mother, who was nothing if not practical, had a number of falls in her home of (eventually) 60 years before one finally changed her answer from “not ready” to “I think it’s time”.
The sad fact is that there will eventually come a time when all the choices a senior has today are taken away. A serious fall is the most common thief of those choices. At that point, a nursing home may be the only option left and the choice may be based on availability and care needs. It is the nightmare scenario and the senior needs to be made aware of and consider those unpleasant possibilities.
The second objection is price. Sticker shock can be a major deterrent when seniors first consider a LTCC. A monthly fee of $5k or $6k can seem shocking, perhaps even eliciting gasps of disbelief from a senior who remembers paying less than 25¢ a gallon for gasoline! It is a lot of money ... but compared to what?
The $5k or $6k covers 24/7 care and some, if not most or even all, of the following: med management, utilities, some meals, weekly housekeeping and linen changes, planned activities, socialization, excursions and much more. It is also a far safer living environment that includes regular visits by a doctor (house calls!) and is fully staffed by medical professionals.
That must be compared to the cost of: mortgage, taxes, insurance, utilities, phone(s), cable tv, transportation, home repairs, upkeep, maintenance and more while living at home. Beyond those quantifiable costs, what is the cost of isolation and inactivity? What about the possibility of nutritional issues, medication mismanagement or in-home aides, if needed? The fact is that the cost of living at home can dwarf the cost of a LTCC.
A detailed cost analysis, listing out all the costs of both scenarios, should be performed as the first step to overcoming any objections to the cost of LTCC.
The third objection, which feeds the others, is the preconceived notion of what these communities are like. Far too often, the picture in a senior’s mind is a memory of a nursing home they may have visited 30, 40, 50 years ago. From personal experience, I can vouch for the fact that the sights, sounds and smells of those places are not easily forgotten but nothing could be further from the truth in the year 2020.
Independent and Assisted Living communities are a fairly recent development (1990s) that have been described (accurately, in many cases) as being like “living on a cruise ship 24/7”. One visit to one of these communities may be all it takes to change that misconception. We have worked with clients under that misconception and it is always fun to watch their jaws drop when they enter the lobby of a beautiful community or watch them thoroughly enjoy a delicious meal in the restaurant.
Next: A closer look at Independent Living & Assisted Living Communities.