Planning Ahead Can Save on Health Care

Eva, 74 and a widow, was a healthy and independent woman until she went shopping one day last December and was mugged. She was attacked with a screwdriver and thrown to ground, breaking her shoulder in four places.

"I ended up on the sidewalk, totally helpless," said Eva, who lives in Westwood and prefers to not give her last name. "I went from being very active to being disabled. My recovery was very painful, and I am still not done."

Eva was hospitalized for a month, and when she came home, she found that she needed nursing care and help doing basic tasks around the house, such as bathing and getting dressed.

"A nursing home just didn’t appeal to me," Eva said, and so she found home care. The cost of such care was between $17 and $20 an hour, and Eva needed it at least 16 hours a day for six months.

The cost of her care could have totaled in excess of $55,000 for those six months. However, Eva was able to avoid the expenditure because she had a long-term-care insurance policy that she bought the year before. The premium cost $2,273.

Because elder care can be an enormous drain on an individual’s resources, with nursing homes costing in excess of $100 a day and home care costing even more, planning ahead and buying long-term-care insurance is one way of preventing the costs from being too overwhelming.

For some in the Jewish community, long-term-care insurance — and particularly the home-care policies — can also have a religious significance. They see it as a facet of the mitzvah of Kibud Av V’em (honoring one’s parents), because it allows children to have peace of mind about their aging parents living out their last years with dignity.

In a 1998 article written by Joel Schwartz in the Association of Orthodox Jewish Scientists Newsletter, Schwartz argued that according to Torah, home care is preferable to nursing-home care, because institutionalized living brings with it a certain loss of honor. While some nursing homes are cheery and bright, others may be drab, unfriendly and, in some cases, even detrimental to the health of those who need care.

Government regulations require nursing homes to provide 3.2 hours of care per patient per 24 hours. In some cases, a nursing home might cut corners because it does not hire enough staff to meet the requirement.

In such a scenario, which some experts in the field say is not uncommon, patients who are severely incapacitated will suffer. They said bed-ridden patients might develop bedsores, because they are not turned often enough, and incontinent patients might be diapered to save labor costs.

Few people want their parents to suffer such problems, but many with aging parents have their own families to provide for and do not have the time or resources to take proper care of their parents themselves.

For many people, long-term-care insurance provides the answer to the problem. Although the premiums might appear high — and even seem useless if the person paying them is healthy — they can end up saving people tens of thousand of dollars if the need for long-term care should arise.

Karen Shoff, a Santa Monica gerontologist, insurance agent and author of "There’s No Place Like a Nursing Home: Four Powerful Steps That Will Change Your Life" (Invisible Ink, 2002), believes that planning for one’s physical retirement is as important as planning for one’s financial retirement. Shoff advises people to start planning for their twilight years in their 50s and 60s, so that they will be able to avoid both nursing homes and the costs involved with home care.

Shoff’s plan involves buying a long-term-care policy, appointing a geriatric-care manager who can assist with legal and medical issues and find services, making a living will that spells out how a person wants to be cared for in the event of an illness and finding an ally who will help carry out the plans.

"You can’t wait until the fire’s there, and people are tearing their hair out," she said. "You need to plan ahead logically."

However, there are some who shy away from long-term-care insurance because they see it as unnecessary to pay premiums above and beyond health insurance and Medicare, which they believe will cover most emergencies. Furthermore, many people argue that, depending on the circumstances, nursing homes can provide better service and offer a wider variety of resources than a home care, in addition to having a social setting that might not be available at home.

"There is an understanding in halacha [Jewish law] that sometimes a parent needs to be put in an institution — for example, if the parent has dementia, and the children can’t handle the burden" said Rabbi Elazar Muskin of Young Israel of Century City. "You need to weigh up the circumstances."

Still, others credit their long-term-care insurance and the home care it bought them with peace of mind. "When I took out the policy, my children kept telling me that I was throwing money out the window," Eva said. "But after I was mugged, they were relieved that I had this help, that I was OK and that I was not going to be dependent on them."