THE SETTINGS & COSTS OF LONG-TERM CARE (LTC) SERVICES: The Costs of Long Term Care (LTC) services for a chronically ill individual vary greatly, depending on the Care Setting (e.g. Home or Facility); the type of care you receive; and the makeup of the Care-givers(Paid and Non-paid). For example, if a chronically ill individual is able to remain in his/her own home by virtue of substantial daily assistance from a combination of sources (spouse, family members, friends, Home Health Aides, etc.), then the sum of all of the Direct and Indirect Cost Components of related LTC Services will be considerably less than commensurate care in an Assisted Living Facility or in a Skilled Nursing Facility.  The reasons are obvious:  In the Home Care setting, there are no Facility-specific Room & Board charges and there is generally a very favorable ratio of voluntary "Non-paid" helper(s) to "Paid" Home Health Aides.  Nonetheless, there generally is a "crossover" point, when Home-based Care should yield to Facility-based Care (be it Assisted Living Care or Skilled Nursing Facility Care).  That "crossover" point from Home-based Care to Facility-based Care symptomaticlly reveals itself When the chronically ill individual experiences excessive anxiety regarding the punctuality of "scheduled" resources; When more advanced medical equipment is regularly required;   When the voluntary "Non-paid" helpers are literally spent/burned-out; When the "Paid" Home Health Aides' skills fall short of the escallating requirements; When the overall daily costs of the In-Home LTC services become greater than the overall daily costs of a Facility. The Following LTC Cost Components are Discussed: 1.) The Direct Services Costs 2.) The Indirect Services Costs a.) The Ancillary Costs b.) The Human Costs c.) The Physical Costs d.) The Emotional Costs

1.) The Direct LTC Services Costs: When planning for your future long-term care expenses, it is quite important to anticipate what the cost of care will be in the future. According to the General Accounting Office, the annual cost of long-term care is growing by 5.8% per year. This means that in 10 years the cost of long-term care could be 75% more expensive than today. For example, in 2017 the minimum 4 hours/day billing for a Home Health Aide is projected to  amount to $153 per day, costing $55,845 annually.  In this example, In-Home Care in 2017 costing $55,845/year compares favorably to the projected, much higher $169,000/year cost of a private room in a Skilled Nursing Facility. In the above example, extending the 4 hours/day In-Home services of a Home Health Aide to 8 hours/day in 2018 will amount to $324 per day, costing $118,260 annually.  At this level of financial exposure, the escallating daily cost of In-Home Care is noticeably ratcheting-up and the option of Facility Care may offer welcome relief on multiple fronts. Immediately below is a 5 year picture of the projected $833,000+ in personal Financial Exposure for LTC Services over the period of Jan. 2017 through Dec. 2021: Example Claim Period is 5 years of Jan, 2017 thru Dec. 2021 1st Year: 2017 LTC Service: Home Based LTC Services Home HealthAide 4 hrs./day Per diem Cost $153/day Annual Cost (Min.) $55,845 2nd Year: 2018 LTC Service: Home Based Services Home Health Aide 8 hrs./day Per Diem Cost: $324/day Annual Cost (Min.) $118,260 3rd Year: 2019 LTC Service: Facility Based Services Nursing Home - Private Room Per Diem Cost $520/day Annual Cost (Min.) $189,800 4th Year: 2020 LTC services: Facility Based Services       Nursing Home - Private Room Per Diem Cost $551/day Annual Cost (Min.) $201,115 5th Year: 2021 LTC Service: Facility Based Services Nursing Home - Private Room Per Diem Cost $584/day Annual Cost (Min.) $213,160 5 Year Total of LTC Financial Exposure: $833,295

2.) The Indirect Services Costs: a.) Ancillary Costs: Besides the normal daily rate that a nursing home will charge you, or the hourly rate that a home care agency will charge you - there are always going to be ancillary costs associated with your care. In a nursing home or at-home, additional expenses could be medical specialists, therapists, medical and surgical supplies, diapers, medications, and other incidentals. In your home, there can be additional expenses such as safety devices (i.e. grab bars near the bathroom and toilet, and maybe a ramp for the stairs).   Collectively, these Ancillary LTC costs can amount to another $100+/day, adding another $36,500 per year to the LTC out-of-pocket cost. b.) Human Costs: If a family member decides to provide the care rather than paying a professional, there are many human costs besides financial costs to consider. Your family may or may not be aware of these, or be prepared for them. If your plans are to save the expense of paying someone to care for you and rely on a family member instead, you need to consider the costs that they may pay - financially, physically, and emotionally. While, they may be more than willing to take care of you, they may be unaware that there may be a financial cost to them. The financial cost to them could be very high.  If they currently work, they may need to work fewer hours, or even give up their jobs altogether.   Such informal family caregivers will lose nearly $660,000 in a lifetime due to their caregiving sacrifices. c.) Physical Costs: Providing long-term care is hard work. Family members may become exhausted from the long hours of care giving. If you had a stroke and could not bear your own weight it could be very difficult, if not impossible, for a family member to lift you in and out of bed. Especially if your caregiver were your spouse and you are both in your 80’s! If you have Alzheimer’s and require 24-hour care, it can be very exhausting for a family member to stay up all night and during the day. Your family caregiver couldn’t do that for too many days in a row! d.) Emotional Costs: The emotional toll that caregivers experience is another cost your loved ones may pay in providing care to you. If you are relying on a family member to take care of you, it is important to understand the type of care you may be asking them to provide. You may be thinking that the extent of the care is helping you in and out of bed, assisting you with meal preparation, or driving you to the doctor. But, what if you need more care than that? Will it be possible for the friend or family member to handle more extensive care?