How the Pandemic Is Changing Long-Term Care and What to Do About It

The COVID-19 pandemic has changed long-term care (LTC). Chang-es will continue even after effective vaccines are widely administered. You need to adjust your long-term care (LTC) plans in response to these changes.

The most serious consequences of COVID-19 were concentrated among older Americans, and those residing in long-term care facilities fared the worst.

A study by The Wall Street Journal concluded that there were more than 100,000 deaths linked to coronavirus among U.S. LTC residents. This was at a time when total coronavirus-related deaths were estimated at 250,000.

Other researchers pegged the percentage of total coronavirus deaths among LTC residents at 40% and higher.

Concentrating people needing LTC in relatively large residences has benefits. But it also makes these vulnerable residents even more vulnerable once a contagious virus enters the facility. In addition, state regulators and LTC residence operators sought to limit spread of the virus by isolating the residents.

Visitors were prohibited or severely restricted. In many facilities, residents were required to stay in their rooms or apartments. Numerous studies have shown that social isolation such as this increases the decline in mental and physical health in the elderly.

Another consequence of the pandemic is that LTC owners and operators face greater financial strain. New procedures instituted because of the pandemic increased costs. Fewer people want to work at LTC facilities, so turnover is higher, and salaries are increasing. Meanwhile, fewer people are seeking to enter LTC residences because of the pandemic. Vacancy rates have increased.

At the same time, extremely low interest rates are hurting LTC insurers. They can’t invest policy premiums to earn as much money as they expected. In the past, surveys found that most people preferred to age at home for as long as possible.

Now, I think more people will avoid, for as long as possible, large, assisted living residences or nursing homes. More people will want to age at home. There also will be more resources to make this possible.

You should adjust your LTC plan to emphasize staying in your home as long as possible by receiving LTC there instead of entering a large LTC residence.Start with your residence. Reevaluate your home by considering its potential for LTC and aging in place.

If you plan to move, select a home that is suitable for when you might not be as mobile or able to perform all the activities of daily living. Opt for a place without stairs or that at least allows you to live full time on the main living level. Look for other aging-friendly features in a home. You even might want room for one or more caregivers, especially if you’re hoping that relatives will be able to help.

If you don’t plan to move or don’t find a home that’s suitable for receiving LTC, that’s not a problem. Most existing homes can be modified to accommodate people as they age. I addressed details about how to modify an existing residence and what to look for in a new residence in the August 2017 issue. The key point is not to wait to take action until it’s looking like you might need help and home modifications.

At that point you won’t be able to make changes yourself and probably won’t be able to plan and oversee the changes. Develop a plan and set it in motion while you’re healthy.

Another consequence is that the cost of LTC is likely to increase, regardless of how and where you receive the care.There already was a shortage of LTC workers, especially home care workers. That’s only getting worse.

One way to reduce the worker shortage is to increase compensation, which will increase the cost of your LTC. The cost of home care already was increasing so the cost difference between home care and an assisted living residence was reduced in recent years. That gap will close some more.

The good news is that about 96% of LTC insurance policies already cover LTC regardless of where it is received. Most policies cover home care, adult day care, assisted living, nursing home care and more. Premiums continue to increase on traditional LTC policies, and fewer of them are issued each year.

The hybrid LTC policies now are more popular. They’re also called asset-based policies and leveraged care plans, among other names. The hybrid policies generally are annuities or permanent life insurance policies with LTC benefits or riders included. The hybrid policies have several advantages over traditional LTC policies. If you need little or no LTC during your lifetime, your beneficiaries receive benefits from the policies.

These aren’t use-it-or-lose-it policies as traditional LTC policies are. Many of the hybrid policies also are indemnity policies instead of reimbursement policies.

A reimbursement policy requires you to first incur LTC costs and then apply to the insurer for reimbursement. In an indemnity policy, once you qualify for LTC benefits, you re-ceive a monthly check. You can spend the money however you want.

You even can pay a relative to provide LTC in your home.I discussed LTC insurance, including my current favorite policy, most recently in the June 2019 issue. For more details about LTC insurance, contact David Phillips or Todd Phillips at Phillips Financial Services at 888-892-1102 or visit their website at www.epmez.com.

Another aspect of LTC that’s changing is technology. There have been many innovations in technology that allow people to remain in their homes longer than in the past. Technology allows medical providers to remotely ad-minister tests, evaluate your health and communicate with you.

Technology also can allow you to perform tasks around the home that you wouldn’t have been able to do a few years ago, allowing you to live there longer. The pandemic has increased interest and investment in this area. There are likely to be more innovations in the next few years. As you age, technology can be your friend.

You also should be aware of new and expanding programs that allow LTC to be delivered either at home or in smaller, homelike setting instead of large residences.For example, the nonprofit Green House Project has helped promote senior living in more than 300 small, home-like settings in dozens of states. For details, visit www.thegreenhouse-project.org.

Medicare has a community-based program called PACE (Program of Inclusive-Care for the Elderly) that currently is helping about 50,000 people with medical services, day care, home care and transportation. Most of its participants are eligible or both Medicare and Medicaid.

In recent years, Medicare has al-lowed Medicare Advantage plans to choose to provide additional benefits, often delivered at home, such as enhanced disease management, nutrition education, meal delivery, transportation benefits and bathroom safety devices. Not all Advantage plans offer these benefits now.

I expect Medicare will expand the availability of such services it pays for as policymakers realize that helping people in this way is less expensive in the long term.