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The Senior Hub Podcast is a resource hub for planning and caring well for your aging parents and loved ones. This podcast tackles everything from data, to key terms, to personal stories, to sacred moments, to tricky family dynamics.
Join hosts Daniel Alexander and Rebecca Hill as they engage their guests, and each other, on this most important topic. We are all learning about this topic as we get older. Let's do it together.
Find us at www.theseniorhub.com
Hello, and welcome to the Senior Hub Podcast. I'm Daniel Alexander, the founding director of The Senior Hub, and I'll be your host for today's conversation. Our hope is that each time we do this, by the time we're done, you'll feel a little more equipped and maybe even a little more hopeful for whatever's ahead. So without further ado, let's dive in. Today, we have with us once again Rebecca Hill, our chief care strategist of The Senior Hub.
Speaker 1:Welcome, Rebecca.
Speaker 2:Happy to be here, Daniel.
Speaker 1:Glad to have you. To recap, we are in a series about Margaret. Margaret is a 78 year old who lives in Raleigh. She has one child that lives in town with her and two that are out of town. She fell, broke her hip, had surgery in the hospital, and then went to a skilled nursing facility.
Speaker 1:While there, the bills began to arrive, and the confusion started to set in. The last episode, we pulled back the curtain on Medicare part a, what it covers, and where it ends. So today, we're talking about the costs on the other side of rehab because Medicare a was in play with rehab, and now Margaret is preparing to leave rehab. And we need to think about what are the costs as we look out to the next phase. Who pays for it, and what conversations do these families need to have as we prepare for this moment?
Speaker 1:So, Rebecca, let's dive in. Medicare a ends at the end of rehab, as you said in the last episode, if I'm correct. Yeah. And families considering the costs. Talk to us about the main things they need to be thinking about as they look out the door and consider where's where we're going next.
Speaker 2:Yeah. So, we need to consider the episode is ending, if she has hit that one hundred day cliff or not. So if she has rehabbed in the skilled nursing facility up to one hundred days, is she now paying for that skilled nursing care out of pocket? What that looks like could be, hundreds, if not thousands of dollars out of pocket.
Speaker 1:Per day?
Speaker 2:Per day.
Speaker 1:Wow.
Speaker 2:And so as you consider that, you then want to consider what are your options. So is skilled nursing really necessary? Assisted living may be an option that's a little more forgiving. The more support she needs day to day, the higher that number climbs.
Speaker 1:Okay. So let me recap. You're saying if it turns out she's not able to leave skilled nursing yet. Correct. And you've hit one hundred days, and she needs to stay in skilled nursing, you're saying that becomes out of pocket cost versus Medicare.
Speaker 2:That's right.
Speaker 1:And that can get very expensive very quickly.
Speaker 2:Hundreds to thousands of dollars per day.
Speaker 1:Okay. So other options are living facilities and other places where she can start considering moving into or plugging in. Again, the cost is what we want to talk about today with that. Give us give us a little bit more. I'm really curious about the costs here.
Speaker 1:As we consider, let's do the scenario of she's not going home first.
Speaker 2:Sure.
Speaker 1:If she's moving into a community
Speaker 2:Yeah.
Speaker 1:Perhaps for the long term, Start talking to me about how much these things cost.
Speaker 2:So I'm going to give you ranges here because the costs change on average every six months or so. And then, you know, very specifically, the costs are gonna come down to what are her daily needs. But assisted livings in the Triangle area can be between 5 and $10,000 per month. I know that sounds like a broad range, but there are nuances and specific tasks associated with what the assisted living is doing for Margaret. Okay.
Speaker 2:But that's double some people's mortgage payment.
Speaker 1:Sure. So 5,000 to $10,000 a month for assisted living is the name of that. Right. In future episodes, we maybe will break down what all these terms mean.
Speaker 2:Sure.
Speaker 1:What other types of communities are there, and what kind of costs are there besides So just this assisted living
Speaker 2:the range is, you know, elder care starts with independent living. Those can be between 3,000 and $7,000 per month. Some of those communities do have additional supports available contracted with each individual family. That's something to talk about and we can unpack later. Assisted living is, you know, supported supported by nurses overseeing caregivers who are delivering support in an assisted living environment.
Speaker 2:And then there's memory care, which, even if Margaret doesn't need it now is worth naming because it's typically the higher cost, tier of communities. And then we have what's called continuing care retirement communities, which you can step step in in the independent living stage, and they can see you all the way through to a skilled nursing care need.
Speaker 1:Okay. Okay. And those, I assume, have a higher cost as well if they have all the services involved.
Speaker 2:And we'll deeper dive on that.
Speaker 1:Okay. But I heard you just say between 3,000 and $15,000 a month, or even more if necessary on the memory care side, is what we're looking at just for the living costs.
Speaker 2:That's right.
Speaker 1:As we're considering moving forward. Does Medicare cover any of that? None. None. Medicare doesn't gonna cover the the living costs.
Speaker 2:Not at all.
Speaker 1:Okay. Darn. I was hoping that they would they would jump in.
Speaker 2:Wish I had better news.
Speaker 1:Okay. Alright. Talk to me about going home and the costs associated that we need to be thinking about with that.
Speaker 2:Yeah. So if we're beginning to talk about home care, that is a different math problem because it's billed hourly And families underestimate that a few hours a day for bathing and meals, medication, can can really add up much faster than people expect. And then, you know, sometimes you're adding home care in addition to other supports, or you may have moved into an an independent living community and you need more support on top of the, you know, room board meals that you're being offered, you need to account for that cost.
Speaker 1:Okay. Can you give me any dollar ranges if you're saying this is by hourly?
Speaker 2:Sure.
Speaker 1:Are we talking $15 an hour, $175 an hour? What are we
Speaker 2:talking Yeah. So I mean, depending on, how you're sourcing your home care. So there are registries online where people work for themselves. You don't have a contractual arrangement. You're paying people by Cash App or Venmo or just, you know, dollars in hand.
Speaker 2:Agency oversight and skill level is gonna drive your cost per hour. So the people who are neighbors and and, or friends who you're just hiring for watchfulness
Speaker 1:Mhmm.
Speaker 2:Are probably the lowest rate of care. But you're looking at, you know, dollars 20 an hour to maybe $40 an hour for home care.
Speaker 1:Okay. So can you do the the math for us so we don't have to? If I need two hours well, let's say I need four hours a day because there may be a minimum number. Four hours a day every day for a month at the average range, what kind of numbers are we talking about here?
Speaker 2:Yeah. You could be talking about between 7 and $10,000. If you needed round the clock support, you're looking at up to $30,000 per month.
Speaker 1:$30,000 a month.
Speaker 2:I know. It's an eye opener.
Speaker 1:For in home care.
Speaker 2:Yes. I know. Okay. That's a hard pill to swallow for sure. And again, does insurance help
Speaker 1:with any of that?
Speaker 2:So long term care insurance can help with that. You know, there are some veterans assistance that can help, but, again, those are you have to qualify to submit those claims. There's a process to that. We can even, you know, talk a little deeper about that in later episodes or maybe even at the end of this episode. But Okay.
Speaker 2:Yeah. So so the answer to that is maybe. Largely out of pocket. Largely out of pocket.
Speaker 1:Okay. Alright. That's that's care. What else do we need can be considering in terms of costs in home Yeah. As Margaret continues to move towards that chapter?
Speaker 2:Yeah. So there's the medical equipment and supplies. Say Margaret now needs a walker to ambulate safely or move safely through her house. She might need a shower chair or wound care supplies, incontinence products. Transportation is a huge thing that people forget.
Speaker 2:She's going to have follow-up appointments and if she's not driving after that hip replacement, then she's gonna need somebody to take her there or, Uber, Lyft, back and forth. Home modifications, say it's not really safe for her to navigate stairs any longer and she needs a stairlift from Floor 1 To 2, there's a cost there. You know, grab bars, ramp, all of these things are things that need to be upfit to the home and there's an out of pocket cost for that. And you're gonna need someone to do those installs for you, etcetera.
Speaker 1:Okay. I feel like I heard you say in a previous episode something about Medicare b.
Speaker 2:Right.
Speaker 1:Can you help me there?
Speaker 2:Yeah. Okay. So, Margaret will need physical therapy, maybe occupational therapy, and depending on her other factors, she might require speech therapy. Those are therapies that are covered under Medicare part b. Okay.
Speaker 2:And we haven't dipped into this pool of Medicare money yet because these are outpatient reimbursable therapies.
Speaker 1:Okay. So Medicare B does not cover necessarily the grab bars or the stair lift, those kind of things? No. No. Covers more of the services she may need her continued rehab but not in the skilled nursing facility.
Speaker 2:You got it.
Speaker 1:Okay. What about Medicare C or D, the prescription conversation?
Speaker 2:Yeah. So, again, Medicare, C is, the Advantage Plan, D is the prescription drugs. It will cover some, but not all. And so you do need to prepare for out of pocket costs.
Speaker 1:Okay. And I assume that's an incredibly complex conversation as well.
Speaker 2:That's why we're gonna
Speaker 1:Keep moving.
Speaker 2:End it there.
Speaker 1:Alright. Fine. Keep moving. But Medicare Part D is prescription. We need to be asking that.
Speaker 1:I assume supplemental could help with prescriptions as well.
Speaker 2:Yes, potentially.
Speaker 1:Okay, depending on what you have how
Speaker 2:you're What's prescribed to
Speaker 1:you. Up. All right. So a lot of different pieces to those costs that you need to be looking into. All right.
Speaker 1:Let's transition then to the cost of doing no planning. If this is a crisis, I assume we're up the creek a little bit more. But, what does it actually cost when a family doesn't plan? Like, talk me through what you've seen in in some of these situations.
Speaker 2:Yeah. So this is the reframe. I wish that that people would consider earlier earlier on. It's just, because planning always sounds like the expensive option and not planning is in fact the expensive one. The more information you have, the better informed you can move forward in the decision making process.
Speaker 2:It just doesn't show up on a bill. Right? The cost of not planning. So a rushed decision is always the most expensive decision because you're backed into a corner. A crisis move into a memory care, you know, arranged over a quick period of time because there's no other choice or because you just simply don't have time to research those options is a costly one.
Speaker 2:Yeah.
Speaker 1:Yeah. Okay. So that's you're paralleling idea of having to go out and buy a car today versus having the chance to talk to a couple different car places and research and figure out the right thing. So Exactly. Certainly makes sense.
Speaker 1:Are there other costs that you've seen about associated with doing nothing?
Speaker 2:Well, I mean, certainly, if somebody goes home without the supports they need and then they fall again, well, then then there's the other, you know, time cost, you know, situation where a second fall, one one that home modifications could have prevented means another ER visit and maybe surgery, a hospital stay, and thoughtful planning could have avoided that whole readmission.
Speaker 1:Okay. So you're saying if I spend $500 on some home modifications, that may prevent thousands of dollars and hundreds of hours on down the road.
Speaker 2:For sure.
Speaker 1:Got it. What about thinking about the caregivers themselves, which is a lot of people that are listening to this podcast?
Speaker 2:Right.
Speaker 1:How do you think about them in these moments?
Speaker 2:Yeah, so I feel like the time that caregivers are spending actually giving care isn't accounted for always. The lost work opportunities, the time spent to play catch up on your own, you know, life requirements isn't really calculated or acknowledged always, and this is a huge piece. People, are not advancing their careers because they are taking time out to care for mom and dad when they could be defraying that cost by actively planning and engaging supports that make sense along the way.
Speaker 1:All right. That's another huge topic that we'll get into another point. Let me circle us back then to money, like the actual brass tacks of the money here. Who's actually paying for all these out of pocket costs? Who actually have you seen steps in in that way?
Speaker 1:And if it's not always the senior, like, how do families start thinking about navigating that?
Speaker 2:Right. I think a lot of families have a picture in their head that doesn't really match what's actually happening. It's usually not one source of, you know, supplement funding, it's a combination. So it's Margaret's assets, her income, whatever insurance benefits will contribute. It's almost never one source, and it's sometimes all three at once.
Speaker 2:The other piece is that families are making, you know, financial contributions. This happens far more often than people talk about openly, and this is actually part of the opportunity cost problem. And families rarely sit down and name this in advance, and this is a potential fracture maker and resent resentment builder.
Speaker 1:Okay. Can you give us a scenario, where you've seen this without names, of course, and what advice you have for families who are upstream of this at the moment. Like, how do they act what does the conversation actually look like when you're talking about money Mhmm. And all the costs that may come down the road?
Speaker 2:Yeah. I think naming who is going to be the point person in the family to guide. There's always one family member who's geographically local, who is the person who is guiding all of the, all of the hospital communication and then all of the follow-up after after Margaret gets home. I think just having the conversation about how each family member can contribute and their role and responsibility and acknowledging if one person is contributing more than the than the others is a really valuable understanding.
Speaker 1:Okay. I'm hearing you say it's good to have conversation.
Speaker 2:Absolutely.
Speaker 1:And to bring all the pieces to the table, I could see the person that's local investing hundreds of hours Yeah. And also perhaps dollars, and the people that are not in town not doing the hours, maybe their dollars, but but the important piece that I'm hearing is talking that through.
Speaker 2:And everyone can contribute. You know, I've seen families where the one local person then moves into, you know, mom and dad's home and is on-site to give watchfulness and just be there. And then the not local family members think, well, she's got it all covered. How can I contribute from here? There are ways, especially now with all the, you know, technology options we have.
Speaker 2:You can create inventory lists, you know, send supplies to the house, you can get on Zoom calls and attend those medical appointments. There are always ways to contribute, but they're not easily identified in crisis.
Speaker 1:That's very good. Yeah. I would love to flesh that out more as well. The idea of a a Zoom call instead of the local person having to go to everything Exactly. Would probably give a a lot of relief as you
Speaker 2:Yeah. Okay.
Speaker 1:I want to circle on one other thing that you mentioned in a previous podcast, and that's long term care insurance.
Speaker 2:Right.
Speaker 1:How does that factor as we talk about where Medicare doesn't cover and then as the costs are going on with the family navigating that? Circle back with me on Medicare, I mean, on long term care insurance for a moment.
Speaker 2:Yeah. So if Margaret has long term care insurance, she's going to have to qualify to submit a claim. That usually looks like a nurse either doing a phone call or a a visit to Margaret to just ensure that she needs help with at least two or more activities for daily living in a day. And activities for daily living could be like walking in the home, showering, eating, medications. Now insurance companies are including the cognitive piece and how people are qualified for care.
Speaker 2:And then, you know, with long term care, there is an elimination period usually. It could be thirty, sixty, ninety days, even one hundred days, but you wanna start the clock on that elimination period as early as possible. And then genuinely long term care insurance can be a huge help, in terms of getting the cost of care paid for, but it may not cover everything. So you've got a daily benefit stipend and you've got a lifetime benefit cap. That's the total amount of money that's available to you in that policy.
Speaker 2:The questions you need to ask are, how much is my daily stipend? What is my lifetime benefit cap? And how long is my elimination period?
Speaker 1:Okay. As you you just mentioned, it is super helpful with the cost of care. Mhmm. What are what do you mean by the word care in that situation?
Speaker 2:Well, it could be I mean, long term care does pay for, additional skilled nursing stays, but it also pays for home care. Think of your policy in terms of pools of money. And the question for the family, the takeaway here is ask what pools of money are attached to my long term care insurance policy, and how do I qualify for those to access those benefits?
Speaker 1:All right. So again, the advice is start asking questions about Yeah. How does this And what is it available for and what does it cover?
Speaker 2:That's right.
Speaker 1:As you go. All right. But the first question probably is, do we have long term care?
Speaker 2:Correct.
Speaker 1:And is where's the card? Where's the information?
Speaker 2:Yeah. Go from there. So go going back to our earlier takeaway, early identify where are the supplement insurances? Does she have long term care insurance? What other supplements are available to her, veterans benefits, etcetera, and then move from that knowledge.
Speaker 1:Perfect. All right. So let's wrap this episode up with two suggestions. Will you give me two suggestions that every family that is not in crisis could do upstream when we're talking about costs and the future financial conversations or financial decisions that a family's gonna have to face?
Speaker 2:Yeah. Honestly, don't be afraid to start the conversation early. Getting a real sense of financial picture before crisis forces you to understand is a key. But more than that, understand, you know, a rough at asset assets, income, insurance, everything you can possibly gather to understand the broad financial picture is a great place to start, have the nuanced preferences conversation. You know, this is really the driver of these of these larger conversations.
Speaker 2:You can get the specifics about the policy, but we really wanna understand Margaret and her care needs, not just from a diagnosis or financial perspective, but we just wanna understand how she would like to be cared for, centered. And then start to understand kind of what are the costs associated with aging care in your area, and not just the sense of, you know, from a hospital room, what those costs look like.
Speaker 1:Okay. So I'm hearing you say, figure out what you have.
Speaker 2:Yep. Figure out what you want. Yes.
Speaker 1:And then figure out how much things are gonna cost and how that all come starts to come together.
Speaker 2:Yeah. So much of this is just educating yourself about what's available to you, and then educating each other, having that open communication, not being secretive about where the dollars lie, not being secretive about your true wishes about how family would support you. Naming that early is game changing.
Speaker 1:Very good. Well, thank you for all of that wonderful information. I think it's time for Margaret to go home. We're gonna take her there. Let's do that in the next episode, but I wanna tee up the idea that we need to talk about what is PT and OT and home care at a deeper level, and what are the options for Margaret to feel really supported and to make as much of a recovery as possible as she heads home.
Speaker 1:So let's pause there. Thank you for joining us. Once again, we are thankful for all of you that are listening to our Senior Hub Podcast, and we look forward to having you join us again sometime soon.
Speaker 2:Thank you, Daniel.