Health

HEALTH • Spring 2015 15 Median hourly rate for home health aide services in the Worcester area in 2014 Median daily rate for a private room in a Worcester-area nursing home in 2014 Median annual rate for a single- occupancy room at a Worcester-area assisted living facility in 2014 Maximum assets one can own to qualify for long-term care coverage from MassHealth (excluding home equity up to $802,000) Median annual household income for Massachusetts residents ages 65 and up in 2013 MONEY MATTERS Sources: WilmerHale; Genworth; Interest.com; U.S. Census Bureau $23 $346 $63,432 $2,000 $40,020 Getting older can come with costs that are hard to meet, especially for the middle class. nursing home," Fins said. She said payment options for the elderly who need care, whether at home or in a facility, go some- thing like this: One either is wealthy enough to pay out of pocket, or poor enough to receive a state or federal subsidy. It's those in the middle who struggle to finance the cost of living when they reach their final years. These scenarios are nuanced, of course. Sometimes, those who have always been part of the middle class qualify for some level of subsidy based on economic need. Others qualify for benefits because of their status as veterans. And for those who meet the income requirements, accessing sub- sidies isn't necessarily a cake walk, as Masiello learned. Someone like Fins, an expert in elder care man- agement, is paid to help families find out where they stand as far as financing expenses, including identi- fying subsidies a layperson might overlook. Attorneys and accountants can also advise people on such matters. Masiello, who also consulted an attorney, said the fees are well worth it. "A thousand dollars is worth $10,000," Masiello said of return-on-investment such professionals deliver. The ability to afford care at the end of life is becoming more important as baby boomers age, and as average life expectancy increases. By 2030, there will be about 72.1 million people ages 65 and up — more than twice the number in 2000 — according to the U.S. Department of Health and Human Services (HHS). This age group represented 12.4 percent of the population 15 years ago but will grow to be 19 percent by 2030, according to HHS. But, Fins said, people are often sorely underpre- pared to tackle these costs. She estimated that her average client can pay for long-term care for up to five years. And often, they have to sell their homes to do it, and the assets they had hoped to pass on to their children dwindle away quickly. In Massachusetts, nursing home care costs about $11,000 a month out of pocket, Fins estimated, while assisted-living facilities cost about $6,000 — a lot less, but still well above the average mortgage payment younger people (who still work) face. To avoid spending assets on care in one's later years, Fins said it's smart for people to buy long- term care insurance when they're young and healthy enough to get coverage. But she noted that certain conditions, such as dementia, often disqualify peo- ple for coverage, she said. Home health the most 'bang for buck'? Another long-term care option is home-based care, which can be a less expensive alternative to assisted-living and nursing-home facilities. Reputable home health agencies in Massachusetts generally charge around $20 per hour for services, Fins said. If someone needs only a few hours of care 0 10% 20% 30% 40% 50% 60% 70% 2012 2020 2030 2040 2050 Ages 18-64 Ages 65 and up Ages 85 and up 62.8% 57.6% 13.7% 20.9% 1.9% 4.5% Projected percentage distribution of population by age, 2012-2050 Source: U.S. Census Bureau NUMBER OF ELDERS IN AMERICA ON THE RISE per day, it may be a cost-effective option. But people who are very sick often require round-the-clock care, which adds up to hundreds of dollars per week. Others are too sick for home-based care, and a facility is their only option. But those who find themselves in this situation should do a thorough investigation of their options, said James Fuccione, director of legislative and pub- lic affairs at Home Care Alliance of Massachusetts. Fuccione said often, hiring a live-in aid can be a substitute for nursing home care, and while it's not exactly cheap, he said it is much less expensive than nursing home care. "You're going to get the most bang for your buck Continued on Page 32

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