Cost, quality big factors in long-term care decisions

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Gina Duwe
Monday, September 30, 2013

Recent surveys, government websites and county resource centers offer helpful information on cost and quality of care for families considering late life housing and health care options, local experts said.

Considering cost

Government financial assistance depends on individual circumstances, so officials recommend families contact their county Aging and Disability Resource Center.

Long-term care can be paid out-of-pocket or through Medicaid, Medicare, veterans' payments or private insurance. Many individuals eventually “spend-down” savings and other resources and become eligible for Medicaid, according to the state Office of the Commissioner of Insurance.

Ballpark figures of what people can expect to pay are offered by a 2012 MetLife Mature Market Institute market survey in the Madison area (zip codes starting with 535, 537 and 539) of private-pay, long-term care costs and by estimates from local experts:

Home-health services: For a home health aide trained to provide hands-on care and assistance for daily living activities, the MetLife survey found an hourly range of $13 to $40, with an average of $24.

For a homemaker who provides housekeeping, meal preparation, transportation and companionship, the range was $13 to $30, with an average of $20, according to the MetLife survey.

In-home care hourly rates are based on the level of care needed, ranging in the Rock County area from $15 an hour for tasks such as laundry, up to $23 for skilled assistance, said Pam Hatfield, branch manager at BrightStar in Janesville.

Adult day care: The MetLife survey in zip codes starting with 535 and 537 found a range of $35 to $99 per day with an average of $66.

Assisted living: The MetLife survey in zip codes starting with 537 found the monthly base range was $2,495 to $5,475 with an average of $3,760.

Independent senior living apartments can be about $1,500 a month, said Rick Sheridan of Cedar Crest in Janesville. At his complex, assisted living apartments average $4,500 to $4,600 a month, he said.

At Kelly House in Evansville, owner Diane Skinner said her independent-living duplexes run about $1,650 including utilities. Additional care can be purchased. Supervised care in the assisted-living apartments depends on the care needed but starts at about $2,400 a month, she said.

Nursing homes: Expect a private-pay range of $7,000 to more than $8,000 a month.

The MetLife survey for zip codes starting with 535 and 537 found a range of $5,870 to $9,642 per month for a semiprivate room, with an average rate of $7,452. For a private room, prices ranged from $6,175 to $10,311, with an average rate of $7,939.

 The monthly private-pay rate at Rock County's Rock Haven long-term care facility is $9,125 for private rooms.

Sheridan of Cedar Crest said skilled nursing is around $8,000 a month.

The Wisconsin Department of Health Services also offers searchable directories of facilities and price ranges.

Quality considerations

Government websites can help shed light on deficiencies at facilities and rate nursing homes based on inspections and data, but officials warn decisions should not be based solely on a rating system.

The website medicare.gov offers Nursing Home Compare, which allows users to search and compare quality of care information on every Medicare- and Medicaid-certified nursing home in the nation. It uses a five-star scale to rate facilities on health inspection results and complaints, staffing, quality measures and penalties.

ProPublica, an independent, non-profit news organization, used the deficiencies cited by regulators and penalties over the last three years to compare nursing homes. Deficiencies are rated on an A to L scale, with L being the most serious.

The most serious deficiency reported in Rock, Walworth and Green counties was a “K” case in a Beloit facility where the most severe level of harm was serving undercooked chicken to four residents, according to the report.

The state's directories for assisted living also include licensing and inspection  information.

Jennifer Thompson, division manager of the Aging and Disability Resource Center of Rock County, notes the deficiency findings for some area facilities are for issues such as workers not meeting training levels by a required date.

“If you're checking into a home, ask about the training for all of their employees. Is it up to date?” she said. 

“The deficiencies that I read—I can't think of the last one that was life and death—they're not testing fire alarms,” she said. “Of course there's the occasional fall, and if someone lands in the hospital, those facilities are required, then, to report those accidents, so they're investigated. Sometimes more comes out of that.

“Really, it's fire alarms, doorways being locked” and paperwork not being signed, she said. “But we're not seeing some of those major citations.”

If a family hears a horror story about a facility from one family, conversations with six other families might yield comments such as: “Oh, no, it's a wonderful facility,” she said.

If people have concerns about deficiencies they find online, they should call the management and the state Division of Quality Assurance and ask how the issues were resolved, experts said.


State experts hear every day from people wondering whether they should buy long-term care insurance.

There's no easy answer. One state brochure recommends buying it “if it is right for you.”

Whether you should buy a policy depends on your age, financial status (including your assets and annual income), health, marital status and retirement objectives, according to “Guide to Long Term Care” offered by the state Office of Commissioner of Insurance. The guide, available online at oci.wi.gov, provides a worksheet to help people determine their needs.

Long-term care insurance is not required, unlike health insurance. Policies cover institutional care—nursing homes or other facilities—and care in the community—home health care or other community-based services.

Polices are available to cover only institutional care or cover only community care, such as home health care.

The Board on Aging and Long Term Care offers these issues to consider before buying long-term care insurance:

-- What are you chances of needing long-term care?

-- What is your reason for considering such insurance? Long-term care insurance often is considered to be a mechanism to protect assets.

-- Can you afford the premiums without tapping into savings? No more than 7 percent of your adjusted gross income should be spent on premiums.

-- Will you qualify for medical assistance to help pay for nursing home care?

-- What other financial vehicles might be more appropriate for funding long-term care? Are mutual funds, annuities, life insurance long-term care riders or reverse mortgages among your options?

-- Are you considering the insurance because of possible tax advantages?

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