SAN DIEGO (KGTV) — Long-term care insurance is designed to pay for or reimburse the costs of long-term care.
Long-term care is the help people need when they can't do tasks of daily living.
According to an article from the Office of the Assistant Secretary for Planning and Evaluation, "70% of adults who survive to age 65 develop severe LTSS (long-term services and supports) needs before they die, and 48% receive some paid care over their lifetime. Many older people with severe LTSS needs rely exclusively on family and unpaid caregivers."
Planning for the Unknown
"The way I get through all that's going on with Paul is... I look for the blessings," said Linda Smith.
When you're in love, there's no distance you wouldn't travel to see your other half.
"What would I want if the roles were reversed? If I were the one with Alzheimer's... What would I want him to do? And being with me, this is what I would want, so that's what I'll do for him," Smith said.
So every day of every week, Linda Smith made a 20-minute trip each way to see her husband Paul in a memory care facility.
Linda and Paul Smith met 40 years ago. It was a blind date in Oklahoma City.
"Paul wanted someone to go to the ballet with him," Smith said.
Three weeks later, Paul proposed. Smith says she made him wait a month before she accepted.
It was a chance meeting that turned into the adventure of a lifetime. They raised a family and, as they got older, found the blessings in the little things.
"He always wanted to hold hands when we're walking, so to still be able to hold hands, I think, is important," Smith said.
But just as life has a way of pulling you in with its beauty, it can also be ruthless, ripping at the seams of a once unbreakable bond.
At the age of 62, Paul Smith was diagnosed with early onset Alzheimer's.
"He had a very slow decline for the first four or five years. In the last year and half to two years, it's been much more rapid, especially this year. It's been bad," Smith said.
When it became too dangerous for Paul to live at home, he moved into a memory care facility.
Linda says the facility costs $8,600 a month.
"I look for blessings, and one of the blessings was the long-term care insurance we were able to obtain prior to his diagnosis," she said.
Linda's a planner. She also worked in the healthcare industry, knew the cost of care and was aware of her financial status.
Linda weighed the risk of long-term care insurance premiums against the chance she or Paul would ever need help.
"A lot of people don't get it, not because they don't want it or don't need it, but because they can't afford it," she said. "The premiums for the two of us together ran $6,000 a year. $500 a month if you're anticipating out of your budget."
Linda's plan covers up to $8,000 a month, which is more than 90% of Paul's memory care center costs.
"If we didn't have long-term care, we'd be pulling from his and my retirement accounts and at a young age," Linda said. "If we were 90, that would be one thing, but I'm planning on living to a ripe old age after we're done with this journey, and we would decimate the accounts without this."
Long-term care insurance can cover most skilled nursing homes, home care coverage and residential-type care facilities, among other things.
But it's an added expense.
According to the AARP, about 70% of Americans who reach age 65 will need some long-term care. Yet the percentage of those who have it is nowhere near that.
"Insurance is tricky with Alzheimer's and memory care, and Alzheimer's as a whole," said Janet Hamada Kelley, who leads the Alzheimer's Association San Diego.
Their numbers show the median cost for an assisted living facility last year was about $57,000 on the high end.
For a private room in a nursing home, that price went up as high as $115,000 a year.
"If we look at the facts that one in three will have some sort of dementia or Alzheimer's by the time they pass — that's impacting a lot of people, and as our population gets older, we will see more and more cases,” Kelley said. “So, it's absolutely critical that we have treatments in place to really ensure that those loved ones have access to treatments so that they have more time, more life to live, and of course, better quality of life."
A new but controversial approach to paying for care
This year, the state of Washington launched a state-run long-term care insurance program.
"For everyone in the middle, they are exposed to the risk of this bankrupting them and making people have to quit their jobs to take care of their parent, for example, or spouse," said Ben Veghte, who leads the WA Cares fund. "The WA Cares fund is a program that makes it possible for the broad middle class to have access to affordable long-term care insurance for the first time in this country."
The way it works is workers in Washington have a little over half a percent (0.58%) deducted from their paychecks. After a decade of contributing, they'll be able to get up to $36,500 for long-term care. Veghte says that the amount can go up with inflation.
According to the WA Cares website, "You contribute to the WA Cares Fund for as long as you're working in Washington state. As soon as you retire, you stop contributing. Similarly, if you become unemployed or leave the workforce to care for a child or other loved one, contributions stop. If you access your WA Cares benefit early and return to the workforce, contributions resume."
Veghte compared the plan to Medicare.
"A public insurance model is like Medicare where everyone is in," Veghte said. "You only pay a half a percent of your wages into the fund and there are no tests for preexisting conditions, everyone's covered, women and men pay the same rate, people who have diabetes, people who are healthy, all pay the same rate and when you need care you can access it."
Some lawmakers in the state have spoken out against the plan because it implements a new tax on workers.
A website run by the Washington House Republicans calls for the plan to be repealed.
It's not just Washington that's interested in ways to help. The state of California is also exploring a long-term care insurance program. A report is due to lawmakers by the start of next year.
A task force found most Californians can't afford three months of nursing home care. The task force found almost half couldn't afford even one month.
Update: ABC 10News interviewed Linda and Paul Smith at the memory care facility in San Marcos, Calif., in December 2022. In September 2023, Paul passed away.
