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What is long-term care? It typically includes where you will live and what kind of care or assistance you will need:

• Where will you live if you can no longer manage your present home?
• What are the options if you must make other living arrangements?
• Who will you live with?
• Who will be an assistant or caregiver?
• What will it cost?
• Will you have to move to an adult community or somewhere away from your family?

Although these questions have probably crossed your mind many times, many of us have put off dealing with them just like we put off writing advanced directives or a will. Experts estimate that at least 60 percent of all people will need extended help in one or more of the areas above during their lifetime.

Many options may be available in your area to help you determine what will be best for you. Community-based services like home health and caregiver assistance can be used at your home. These may be covered by Medicare, Medicaid, veterans benefits, or insurances. A variety of alternative living facilities includes assisted-living apartments, assisted-living facilities, boarding homes, retirement homes, nursing facilities, and adult communities.

Don’t Rely on Medicare
Do you know that Medicare doesn’t pay for most long-term-care needs? They may pay for services such as therapies with a physician’s order, but this is only for short term. Don’t be caught unprepared thinking Medicare will take care of you if you have long-term-care needs in the future.

Long-term-care needs for people  with spinal-cord injury (SCI) may not fit into the typical outlines found in many Web sites such as www.medicare.gov, www.longtermcare.gov/ltc, or www.longtermcare.net. 

You may already need assistance for activities of daily living. The aging process with SCI will present additional needs physically and medically.  When your needs can no longer be met at home, another type of facility-based setting for extensive care needs and/or supervision may be required.

Paying for long-term care can be confusing, but there are many options to consider. If you have the funds, private pay could provide services in your home. Long-term-care insurance is another option, but this requires monthly payments and involves eligibility requirements.

Another option is a viatical settlement: If you are terminally ill or chronically ill, you might be able to sell your life insurance policy to another person (a third party). You usually have to sell your policy for a lower amount of the full face value. Before making a final decision to make a viatical settlement to pay for your long-term-care needs, you may want to contact your State Attorney General Office or your State Department of Insurance. (Source: www.medicare.gov)

Reverse mortgages are another option to look at. This is a special type of home loan that lets a homeowner convert a portion of the equity in his or her home into cash, but it has advantages and disadvantages as well. For more information about reverse mortgages, check out the U.S. Department of Housing and Urban Development Web site, www.hud.gov.

The Department of Veterans Affairs (VA) may provide long-term care for service-related disabilities or for certain eligible veterans. There might be a waiting list for VA nursing homes. VA also provides some at-home care if you are eligible. Visit the VA Web site, www.va.gov, to download a Veterans Benefits fact sheet or call 800-827-1000 to obtain information about available services in your area.

One last source may the Programs of All-inclusive Care for the Elderly (PACE) to pay for your long-term-care needs. It is a new benefit that features a comprehensive service delivery system and integrated Medicare and Medicaid financing. PACE combines medical, social, and long-term-care services for frail people. For most participants, the comprehensive service package permits them to continue living at home while receiving services rather than being institutionalized. PACE is available only in states that have chosen to offer it under Medicaid. You can learn more about the PACE program at www.medicare.gov.

Learn, Then Plan
The important thing to know is that by being aware of the possibility of having to make long-term-care arrangements, you can plan accordingly. Learn what options are available in your community. Know what the costs may be and how you will be able to afford your future needs.

By planning ahead, you may be able to start a savings plan or purchase long-term-care insurance. When looking at this option, there are many conditions to the policies you may purchase. Ask a company to send you information, read it over, talk with someone who has this type of insurance, and then call the company with your questions.

Having plans in place will bring a certain peace of mind knowing you will not be a burden on your bank account or your family. By planning for the future, you are more likely to be able to remain at home and receive community services instead of having to move to an alternative facility. Future-planning kits are available online at www.longtermcare.gov.

Copyright 2008, Paralyzed Veterans of America. Reprinted with permission of Paraplegia News.