2 Words That Could Cost Medicare Beneficiaries Everything

Christy Bieber – The Motley Fool

Medicare provides health insurance for more than 55 million people who are 65 or older, or who are disabled. While many look forward to the day they’ll become eligible for Medicare, once you actually qualify, it may come as a shock that there are serious coverage gaps in this government program. 

While there are many things Medicare doesn’t cover, one of the most expensive and important services the program won’t pay for is a service as many as 70% of people who reach the age of 65 will need: care in a nursing facility.

Whether Medicare covers this expensive service for you or not all comes down to one key thing: whether the care you need is custodial care. These two words — custodial care — could mean you’re stuck paying thousands out-of-pocket every month for the care you need. 

What is custodial care?

Custodial care is the term used by Medicare to describe routine assistance with basic activities of daily living. If age or disability makes it impossible for you to do tasks like showering, tending to your personal care needs, cooking, eating, or avoiding hazards in your home, you need custodial care. 

Many people who require either long-term care at home, or care in a nursing home, require only custodial care. The key defining feature of custodial care is that it can be provided by someone without any special medical training. If an unskilled home health aide could provide the care — like moving you from a wheelchair to a bed, or helping you to make and consume food — Medicare will pay nothing at all for your care.

Custodial care is distinguished from skilled nursing home care, which Medicare does provide limited coverage for. Skilled nursing care is defined as care provided by someone with medical training, such as a registered nurse, a physical therapist, or an audiologist. If you have had a qualifying hospital stay, Medicare will cover up to 20 days of skilled nursing care with no coinsurance costs, as well as an additional 80 days with coinsurance charges. 

Custodial care comes at a big cost

Although caregivers do not need specialized training to provide custodial care, the cost of this care, either at home or in an institutional setting, is still extremely high. For seniors who opt for a home health aide, average costs are $4,099 monthly according to the 2017 Genworth Cost of Care survey. For a semi-private room in a nursing home, care costs are $7,148 per month. And if you want a private room in a nursing home, you can expect to pay as much as $8,121 per month, on average.

Obviously, if you’re paying out of pocket, you’ll go through your life savings very quickly, and could lose everything you’ve worked for. What can you do?

Medicare will never cover custodial care, nor will Medicare Advantage, or Medigap plans. This means your only option is to try to find another source of coverage if you don’t want to pay out of pocket.

Having a reserve plan in place which provides reimbursement or cash and care support services to pay for home or care center fees is to own a long-term care insurance policy. People often wait until they are near or want care benefits. Waiting too long is of no advantage as your health (carriers are allowed to be selective) and there are no premium savings if you apply when you are older recommend that you have the conversation about extended care benefits between the ages of 40 and 65. 

Another option is to apply for Medicaid to provide coverage for nursing home care. Medicaid does cover custodial care, it’s a means-tested program, and you cannot qualify for coverage if you have assets are valued at $2,000 or more. This means that you may need to spend a substantial part of your savings before you become eligible to receive benefits. 

Consult a Medicaid planning attorney to structure the ownership of your assets so your wealth doesn’t count for purposes of determining Medicaid eligibility. Making a Medicaid plan can be complicated, and you’ll need to ensure you don’t jeopardize your coverage during the planning process, as you can make yourself temporarily ineligible for Medicaid by transferring assets within five years of the time you need the program to pay for your nursing home care.

6 million seniors received Medicaid coverage in 2015, and 30% of Medicaid’s budget goes toward paying for nursing home care. Creating a Medicaid plan could be one of the best options available to you if you want to ensure you’ll be able to move to a nursing home, or get long-term care services while still preserving your wealth. Another consideration is that transferring your assets means transferring cash flow from your lifestyle. Elder care attorneys do not explain that to people who want to use Medicaid for their care services.

Making plans for long-term care coverage

Ultimately, your best option for covering long-term care is going to depend on your situation. The key is to make some type of plan because if you don’t, you could end up with your life savings going toward paying big nursing home bills instead of being passed on to loved ones. 

The sooner you get your plans in place, the more peace of mind you’ll have in knowing your wealth will be safe, even if you end up among the majority of seniors 65 and over who need some type of nursing home care during the course of their lifetimes.

Warning Signs to Watch for During the Holiday Visit

A holiday visit often gives you a chance to spend time with loved ones you haven’t seen in awhile. These happy occasions can provoke worry if family members notice changes that weren’t there the last time they visited. How does someone tell if it’s normal aging or the beginning of dementia or even Alzheimer’s? Is it time to contact a care professional?

Many of the early signs of dementia and Alzheimer’s overlap. We’ve provided a list of each, with behaviors that are typical in older adults, countered with behaviors that might be found in someone beginning to show signs of disease.

Early Indications of Dementia

It’s hard to diagnose dementia in the beginning stages because the signs are subtle and vary from person to person. However, common symptoms are:

    • Reduced ability to concentrate. Anyone can struggle with managing finances. Someone with dementia might not understand what numbers mean or how to use them.
    • Personality or behavior changes. Anyone can get tired of an activity. Someone with dementia totally loses interest in activities they used to enjoy or needs prompting to get involved.
    • Loss of ability to do everyday tasks. Anyone can get distracted and burn a meal. Someone with dementia has trouble remembering all the steps involved in preparing a meal.
    • Increased confusion and disorientation. Anyone can get lost. Someone with dementia may have difficulty finding their way on a familiar route or be confused about where they are.
    • Difficulty remembering recent events. Anyone might forget an appointment. Someone with dementia forgets them more often or never remembers making them at all.
    • Depression or apathy. Anyone can be down or depressed. Someone with dementia may become confused, suspicious, or apathetic, or have wild mood swings.
    • Loss of language ability. Anyone might forget a word occasionally. Someone with dementia may forget simple words and substitute inappropriate ones, making the person hard to understand.
    • Poor judgment. Anyone can miscalculate the weather. Someone with dementia can see snow outside without thinking a jacket is needed to go for a walk.
    • Misplacing objects. Anyone can misplace the car keys. Someone with dementia might forget what the keys are for.

Be aware that many conditions, some of them temporary, can mimic dementia. Don’t think your loved one has dementia when the warning signs may be due to a stroke, depression, infection, nutritional deficiency, hormonal disorder, long-term alcohol overuse or even a brain tumor. Many of these conditions are treatable. Only a doctor can diagnose dementia. An early diagnosis is critical for treatment, support and making plans.

Is It Alzheimer’s Disease?

No one wants to discover that a loved one has Alzheimer’s, a brain disease that slowly degrades memory, thought and reason. But early diagnosis is crucial for treating the disease to get some relief from symptoms and maintain a longer period of independence. Read on for a list of 10 warning signs and symptoms, adapted from the Alzheimer’s Association’s version. A person may experience these signs at varying levels. If you notice any of the signs in a loved one, have them see a doctor for further evaluation.

Memory loss that disrupts daily life. Anyone forgets names or appointments but remembers them later. Someone with Alzheimer’s forgets important dates or events, asks for the same information again and again, and has difficulty remembering recently learned information.

    • Difficulty solving problems or planning. Anyone makes an error now and then balancing a checkbook. Someone with Alzheimer’s has trouble following a familiar recipe or paying bills.
    • Confusion of time or place. Anyone might forget what day of the week it is, but be able to figure it out later. People with Alzheimer’s can lose track of seasons or the passing of time, where they are or how they arrived.
    • Difficulty with spatial cues and visual images. Anyone might have reduced vision due to cataracts or macular degeneration. Someone with Alzheimer’s has vision problems leading to issues reading, judging distance and seeing the color contrast, which might lead to difficulty driving.
    • Problems with written or spoken words. Anyone can struggle to find the right word now and then. Someone with Alzheimer’s struggles with vocabulary, and has trouble following or joining a conversation, repeating what was just said or failing to continue the thread.
    • Misplacing objects. Anyone can forget where they put something and have to retrace steps to find it. People with Alzheimer’s put things in unusual places, like leaving car keys in the freezer. They may be unable to retrace their steps to relocate an object, or accuse others of stealing it. This behavior typically accelerates over time.
    • Poor judgment. Anyone can make a crummy decision once in a while. People with Alzheimer’s may use poor judgment with money, giving large sums to people they meet over the phone. They may quit taking care of their appearance and cleanliness.
    • Withdrawing from work or social occasions. Anyone may feel like being alone sometimes. Someone with Alzheimer’s might quit hobbies, social outings, sports or work activities. This could be because they’ve forgotten how to complete the hobby or because of other changes from the disease.
    • Mood and personality changes. Anyone can get in a particular pattern and feel irritated when it is disrupted. People with Alzheimer’s can easily be upset at home or work, especially in situations where they don’t feel comfortable. They can become confused, suspicious, fearful, anxious or depressed.

Increasing the Level of Care

Perhaps your concern for your loved one isn’t about cognition at all. You may notice that Grandma prepared a delicious turkey, but she didn’t have the strength to carry it to the table. Maybe her house is dirtier than usual because her eyesight is failing, or she can’t physically sweep like she used to. There is a host of issues you may need to address while you are there or shortly afterward.

Have a conversation with the older adult about what you notice. How does the older adult feel about it? Is Grandma adamant about aging in place, or is she feeling lonely and thinking it might be time for a move to assisted living? Would she like help doing certain tasks around the house, or with errands? Is it time to stop driving?

The caregiving crunch is here

Wall Street Journal – Maddy Dychtwald

Maddy Dychtwald is an author and co-founder of Age Wave, a think tank, and consultancy.

40 million Americans are providing care to an adult family member or friend, most often to an aging parent or spouse. As the massive baby-boomer generation hits their 70s, the demand for family caregiving will skyrocket—and it’s poised to become America’s biggest off-the-books industry.

In order to better understand the caregiving crunch, my firm, Age Wave, in partnership with Merrill Lynch, just completed a study, The Journey of Caregiving: Honor, Responsibility and Financial Complexity, that uncovers the rewards and sacrifices of this complex life stage.
One of the most surprising findings our study uncovered—and it’s good news for us all—is that despite the significant financial and emotional burdens it brings, caregiving seems to give back as much as it takes from the caregiver. Almost all caregivers (91%) told us they feel grateful for the chance to provide care. “At first, it was just scary and stressful,” one focus group participant explained, “but I got to know my mom more deeply. And I learned so much about myself.”

The majority of respondents (65%) also said that caregiving has brought meaning and purpose to their life. Most (77%) went so far as to say they would gladly take on the role of caregiver for another loved one. More than half (61%) told us the biggest benefit of being a caregiver is feeling that they’re doing the right thing. And often, caregivers begin to take better care of their own health as a result of their caregiving experience (86%).

These results suggest that while the caregiving journey can be emotional, physically and financially taxing, caregivers should take a deep breath and work on a mindset that balances the hardships of caregiving with what we’ve found are the many rewards—stronger family relationships and a new role that reflects their values and overarching importance of family in our busy lives.

While some of the emotional costs involved with caregiving are predictable, there are some surprises here as well. One of the unexpected challenges of caregiving is how difficult it is to form a different kind of relationship with a loved one, which often involves a role reversal. The parent who spent a lifetime caring for their children is now the one who needs care and help with decisions, which can be tricky for both the caregiver and their loved one.

Nearly half (45%) of all caregivers say they are struggling with this while trying to meet what they tell us are their top three goals: preserving the dignity of their loved one, providing the best care possible, and keeping their loved one out of an institution. Many caregivers also believe part of their role is to make sure the recipient does not feel like a burden, even when they might be.

Caregivers are on a unique journey where the emotional challenges can feel overwhelming. One of our focus-group participants summarized it well: “I never in my wildest dreams expected to be a caregiver for my father-in-law.  I want to make sure he gets the love, care, and respect he deserves. At the same time, it’s put me on duty 24/7 which has taken a toll on me, my husband and my kids.”

One lesson from all this is that to avoid being blindsided by needing care or becoming a caregiver, people need to start the conversation. They should talk to family about what each person would want or need in a care situation. Determining how adult children might share the responsibilities and support each other—emotionally, financially, with hands-on tasks–is desperately needed but lacking in many caregiving relationships.

Another surprising finding in our study was the scope of caregiving responsibilities, which is far greater than just providing hands-on care. Most (92%) caregivers are providing other types of assistance, including emotional support and financial caregiving.

As it turns out, financial caregiving is a critical part of the picture—but one that’s not often discussed. Financial caregivers in our study are contributing to the cost of care, coordinating and managing finances for their loved one, or both. More than half (52%) of respondents have no idea what they have spent on caregiving-related expenses. In fact, many contribute financially to the care of their loved one even when it’s detrimental to their own financial future.

The cost of caregiving is not easy or comfortable to talk about, but finances are an integral piece of the puzzle. Seventy-five percent of family caregivers have never discussed their financial role with their care recipient. It could be that talking about money is taboo, especially in the face of grave illness, or that the care recipient does not have the mental acuity to discuss finances. But the financial burden and emotional toll can be minimized if families talk it through and plan appropriately.

It’s important to get our heads around the costs and benefits of caregiving now because it’s likely to be in each of our futures. As founder of the Rosalynn Carter Institute for Caregiving, former First Lady Rosalynn Carter once said: “There are only four kinds of people in this world: those who have been caregivers; those who currently are caregivers; those who will be caregivers; and those who will need caregivers.”

Begin the conversation with your family now. It may very well bring you closer together and create stronger bonds that will support you throughout the caregiving journey, whenever that may begin.

Where Is the ‘Assistance’ in Assisted Living?

 Anne Tumlinson – www.nextavenue.org

Pam and her mother both thought that her mom’s move into an assisted living facility would solve a lot of problems. Pam’s father died from ALS, her mother was diagnosed with cancer and Pam started to worry constantly about whether her mom was OK by herself. It was getting increasingly difficult to balance managing her life with helping her mom manage hers.

After Pam’s mom moved, she found that assisted living made some things easier for her. It relieved some of the burdens of cooking, doing laundry and housekeeping, and she worried less about her mom being alone.

But the move hasn’t greatly changed Pam’s workload. And the facility fees are expensive. Pam even had to develop her own written system to help the nurses manage her mom’s medications.

A top-notch assisted living facility like the one Pam’s mom is in can run well beyond $50,000 a year. Pam finds herself asking, “For that price, why am I still in charge of everything?”

Surprising Limits of Assisted Living

Pam discovered that there is a gap between what her mother still needs and what many assisted living facilities are equipped to accomplish. She finds herself coordinating, managing and worrying about many aspects of her mom’s health care.

Assisted living facilities evolved to offer consumers an alternative to nursing homes — to provide a safer version of home that prioritizes hospitality, comfort, and independence over the constant supervision and medical care of a 24-hour nursing facility.

But the problem is that the traditional assisted living model isn’t keeping up with the increasingly complex medical needs of the older adult population. Our parents are living longer with conditions that require doctor appointments and frequent trips to the emergency room.

Adult children, find ourselves managing it all, despite feeling like we have paid steep fees to get help. We are still responsible for coordinating between the assisted living staff, the doctors, and the hospitals; keeping tabs on medications and arranging transportation to medical appointments. Many of us have to hire aides to supplement the facility staff’s work.

Pioneering Assisted Living Programs

Innovative assisted living providers are beginning to recognize the health care needs of residents.

They’re responding with new programs that combine traditional services (like meals) with onsite medical management. They recognize that our health care system is broken and that they can support residents and their families by being the system navigator and advocate.

For example, at Presbyterian Homes & Services, a Twin Cities-based nonprofit senior living organization that serves more than 1,000 assisted living residents in Minnesota, residents have primary care from onsite nurse practitioners who conduct “house calls” to residents’ apartments.

The program also gives the assisted living staff access to after-hours consultation with the medical team. So when something worrying happens in the evening, the staff can get advice and support from the nurse practitioners before making a decision to send a resident to the hospital.

Juniper Communities is an assisted living company also serving over 1,000 residents at facilities in New Jersey, Pennsylvania, Colorado, and Florida. The facility staff, a nurse practitioner and a “medical concierge,” stay closely connected to every resident, to each other and to the family through frequent team meetings, phone calls, and other technology. 

The residents and their children call the Juniper program a significant help and one that relieves their burden and worry. Presbyterian and Juniper say they are sending their residents to the hospital 25 to 50 percent less often than their peers.

Ask 4 Probing Questions

How can we encourage more assisted living providers to offer similar programs? We have to start demanding it.

When you’re shopping for assisted living, here are four questions you can ask of the facilities in your area.

1. How do you prevent unnecessary hospital visits?

Assisted living staff often think they’re doing the right thing calling an ambulance in an emergency, and families many times encourage this. But the hospital is rarely the right place for your frail parent. It can create stress and confusion, lead to infections and complicate delicate care regimens. Ask assisted living facilities how they intervene before health problems escalate.

2. If my mom has to go to the hospital, how will you make sure she has a safe and successful re-entry when she comes back?

The worst mistakes happen between sites of care. So much important information is lost in the transfer. Find out what the facility does to take responsibility for helping their residents get safely to the hospital and back home.

3. Under what circumstances will I need to hire help in addition to what’s included in your fee?

Find out whether the assisted living facility will permit you to bring in your own aides, if necessary, and what they do to support you and that person. Ask also whether the facility has a designated outside agency it works with or whether you’ll have to find the extra care by yourself. Ask, “Who is in charge of my parent’s health care?”

4. How will you spot problems early and communicate concerns with me?

Too many times part of the challenge an adult child will face is getting information about what’s happening with their parent’s health. Find out how and with whom you can communicate to check in on how your mom is doing. And ask whether they are willing to share information directly with her doctor as well.

Don’t Relinquish Your Role

Just because your parent is in assisted living — or even a nursing home — doesn’t end your responsibilities. Navigating the health care system on behalf of a loved one is much harder than it should be and we need allies. We need our team.

As the population gets older, the systems to support it will grow. In the meantime, we are the agents of change — so we can all look forward to a better future for our old age.

Six ways to help your family member or friend with dementia get dressed

Demenita Care Books.com

Getting dressed is a personal and private activity. When people start to have difficulty with it, they often feel frustrated and embarrassed and are reluctant to accept help. Who wants to get dressed in front of someone else, or be dressed by another person? Struggles with caregivers like you can be common.

Dressing is a surprisingly complex task! Many steps and decisions are involved: deciding what to wear, selecting specific pieces of clothing, remembering the order of getting dressed—what to put on first, second, etc.—and coordinating the movements of our limbs with the clothing. And we have to be able to focus long enough to accomplish all these steps.

These are skills that dementia can diminish or take away altogether. As dementia progresses, a person may not be able to:

  • remember the last time she changed their clothes
  • identify items of clothing, confusing a jacket for a sweater
  • recognize or coordinate parts of the body
  • sequence the steps of getting dressed in the right order
  • know what is appropriate for weather conditions or social events
  • manage buttons and zippers
  • have the energy to get dressed or undressed

How can you help make getting dressed easier? Here are six strategies that we have seen work for families struggling with dressing challenges.

  1. Choose clothing that fits comfortably and is easy to take on and off. Look for:
    • garments with front closures. They are easier to reach and let your relative stay involved in getting dressed.
    • blouses and shirts with back closures for people in wheelchairs
    • sweatpants and other activewear that is easy to get on and off, warm, and easy to wash
    • skirts and pants with elastic waistbands
    • items with Velcro™ closures rather than buttons, snaps, zippers and belt buckles
    • “adaptive clothing” that looks normal but has been adapted for easier dressing – like shirts with hidden Velcro closures or pants with zippers down the legs.
  2. Organize closets and drawers. Take some time to:
    • label dresser drawers so your relative can find what he or she is looking for
    • limit the number of clothing items in drawers and closets to simplify the decision
    • remove rarely worn clothes and out of season clothes
    • assemble all articles of clothing and accessories that are to be worn together. Hang pants or skirt with matching shirt, sweater, underwear and any other accessories on one hanger.
    • buy several versions of your relative’s favorite item of clothing. Your relative can wear the same black pants and sweater every day—but you can wash them.
  3. Make sure the area where your relative gets dressed has adequate lighting, is clutter-free, and most of all, is warm! Older adults, especially those with dementia, may need a warmer room to feel comfortable.

When it’s time to help her get dressed, let her do all she can by herself. Being able to dress oneself, even partially, gives a person a sense of control, accomplishment, and independence. These approaches will help:

  1. Follow your relative’s dressing routine as much as possible. How did she start her day in the past? Did she have breakfast before or after getting dressed?
  2. If they are able to choose what to wear, give her two choices. If they are not able to make a choice, have garments ready and within reach.
  3. Layer clothes on a bed in the order in which they will be put on. Put undergarments at the top of the pile, the second article (blouse, shirt, pants etc.) next, etc. Make sure all articles of clothing are right side out. Arranging clothes on a bedspread or blanket of a contrasting color may help a person see the articles of clothing better.

If you encounter problems, try using our Behavior Detective approach to get to the root of the situation. Keep a diary or log in order to pinpoint whether there are particular times of the day when they may be more interested and involved in getting dressed or undressed. The person may be more able and willing to change clothes when they are rested, or when they are following a long-held routine.

Challenges with Family Caregiving

Full Report: 


This comprehensive study shows the vast majority (87%) of unpaid caregivers are family members. Among all caregivers, the population is split almost evenly with slightly more women (53 percent) than men (47 percent). Millennials (34 percent) and Baby Boomers (37 percent) are more likely to be caregivers than Generation X (22 percent). Fifty-one percent are employed either full-time or part-time.

Here are a few key findings:

  • 36% of them provide 100 or more hours of care per month
  • 32% of primary caregivers have been providing care for five or more years
  • 53% of primary caregivers are also employed full-or-part time
  • 21% say their health has declined since becoming a caregiver
  • 22% say their financial situation has worsened

While most caregivers tell researchers their caregiving experience is positive and they do it out of love the real impact creates a tremendous burden on the caregiver and their family. Many caregivers are also holding down jobs, in addition to their caregiving duties. This requires a delicate balancing act according to the study. The survey examined how these caregiving duties may be negatively impacting their employment situation.

The majority of all caregivers are currently employed full or part-time (52 percent). Of the 40 percent of caregivers who are not currently employed, most (65 percent) were never employed during their time as a caregiver. 

For those who were employed the study shows the caregiving had a negative impact on their career. As a result of their caregiving duties, 76 percent of employed caregivers have made some type of adjustment to their employment, ranging from using vacation and sick days to quitting their jobs altogether.

Twenty-six percent of employed caregivers have reduced their hours or job responsibilities. Eighteen percent of employed caregivers have taken a leave of absence. Fourteen percent of employed caregivers have retired early or quit their job. Forty percent of all employed caregivers feel that their being a caregiver has strained their relationship with their employer. Some have experienced adverse actions taken by their employer. Twenty-eight percent of caregivers who are employed or have been employed during their time as a caregiver has experienced adverse action(s) taken by their employer(s) as a result of their caregiving responsibilities.

Being a caregiving impacts even their future retirement savings as eighteen percent of caregivers have taken some sort of loan or withdrawal from their retirement accounts as a result of their caregiving responsibilities. 

For some, the caregiving experience created health issues for the caregiver. Approximately one in six caregivers (17 percent) indicate their general health has gotten worse/declined since becoming a caregiver.

Free Long Term Care Quote

See the full report here: https://www.transamericainstitute.org/docs/default-source/caregivers-research/the-many-faces-of-caregivers-research-report-2017.pdf

The report confirms what many people already know. The family will step in to be a caregiver in a Long-Term Care situation. Caregiving is not easy and has a physical, emotional and financial impact on the caregiver in many situations. This is why more people are planning in advance for the financial costs and burdens of aging. Affordable Long-Term Care Insurance will provide the tax-free resources to pay for quality caregivers in any setting – either at home, adult day care =assisted living as well as memory care and nursing home. This allows the family to be family and not change the relationship from loved one to caregiver which changes the dynamic of the relationship.

Long-Term Care Insurance often will also provide professional case management to help with plans for care and other issues so the family can concentrate on being loving and supporting. The best time to obtain coverage is before retirement as you have the most available options and very affordable premiums.

People require Long-Term Care due to illness, accidents and the impact of aging. The report shows the range of conditions:

Since the risk of needing Long-Term Care is very high having some plan to reduce the burdens and manage the costs of extended care becomes a key part of a future retirement plan. There are three types of insurance products that address Long-Term Care. The traditional tax-qualified policy with includes partnership plans which provide additional dollar-for-dollar asset protection (https://www.ltcnews.com/articles/partnership-plans-provide-additional-asset-protection) asset-based or hybrid plans which combine life insurance or annuities with long-term care and limited duration policies which have reduced underwriting requirements and broader age requirements (https://www.ltcnews.com/articles/new-ltc-policy-options-available-hybrid-long-term-care-and-short-term-care).

Affordable options are available for most people. You work hard and saving money for your future retirement will translate to a more enjoyable and worry-free retirement. Safeguarding your retirement savings (401(k) IRA 403(b) and other assets are always important to longevity.

Most people also don’t want to burden their family members. Plus, people would rather have choices of quality care in the setting they desire without exhausting their savings, burdening their family and making them become caregivers or both.  Caregiving is hard – Long-Term Care Insurance makes it easier for everyone.

Medicare’s Little-Known ‘Two-Midnight’ Rule Could Cost You Thousands

There is a good chance hospital visits will happen as you age, as 15.3% of seniors had at least one hospital stay and 4.9% had two or more hospital stays in 2015.

Unfortunately, some of these seniors paid thousands of dollars more than others — and got far fewer covered benefits — because of a little-known rule called the two-midnight rule.

 Many seniors don’t even know this rule exists, much less realize how it impacts them — until they end up with a huge bill for healthcare services. But you won’t be one of those seniors, now, since you can learn all you need to know about the two-midnight rule right here.

What is the Two-Midnight rule?

Under the Two-Midnight rule, Medicare beneficiaries should be admitted to the hospital as inpatients only if they’re likely to spend two nights — or cross two midnights — in the hospital. 

Unfortunately, this rule means doctors are more reluctant to admit Medicare beneficiaries, especially on the basis of potential complications. If a doctor believes a patient might experience problems after a procedure that normally doesn’t require an overnight stay, the doctor may put the patient in observation status, rather than risk admitting a patient who doesn’t end up spending two midnights.

In one review, researchers found as many as 7.4% of Medicare beneficiaries admitted to the hospital would have been treated as outpatients under the two-midnight rule.  The study also revealed patients arriving at the hospital later in the evening or on weekends would be far more likely to be classified as inpatients compared with patients arriving before 8 AM or on weekdays. 

Not being an inpatient can cost you thousands

Inpatient status matters when you’re a Medicare beneficiary who visits a hospital.

If you’re an inpatient, Medicare Part A pays for a hospital stay of 1-60 days with no co-insurance costs after you pay a standard $1,316 Medicare deductible. Nurses’ services, medications, X-rays, and equipment are all covered by Part A, while Medicare Part B covers services doctors provide. You’ll owe a 20% coinsurance cost for only the Medicare Part B services. 

Not being admitted also means you won’t be eligible for Medicare or Medigap coverage for skilled nursing care if you require care after leaving the hospital. Patients admitted to a hospital for at least 3 days receive coverage for up to 100 days of skilled nursing service — like a stay in a rehab facility. But, time spent in the hospital under observation doesn’t count toward the 3 days necessary for eligibility.

This means you could be forced to pay thousands out-of-pocket for rehabilitation services if you were under observation rather than admitted. In August of 2017, a judge actually allowed a class action to go forward against Medicare brought by beneficiaries forced to pay thousands out-of-pocket for rehab services because they’d been placed under observation status. 

How can you protect yourself from these costs?

You are largely at the mercy of the doctor who decides whether or not to admit you to the hospital — unless Medicare is successfully sued and rules change.

long-term care insurance policy could help ensure you have access to rehab services if you need them and Medicare won’t cover them, but you’ll need to shop carefully for a policy as premiums are often high and some policies have coverage limitations that make them an impractical solution. 

Absent the purchase of additional insurance coverage, try to time your hospital admissions to weekends or evenings when you’ve got a slightly greater chance of being admitted under the two-midnight rule.

Sadly, we generally have no control over when medical emergencies arise… and if you get sick before 8 AM on a weekday morning, the odds are against you. 

Doctors Have Trouble Diagnosing Alzheimer’s. Artificial Intelligence Doesn’t

Alzheimer’s disease is notoriously difficult to diagnose — the only way doctors can tell for sure that a patient has the deadly neurodegenerative condition is to examine his or her brain during an autopsy after death.

That uncertainty is hard for patients who are starting to experience memory loss, which could be an early sign of Alzheimer’s or another, more treatable form of dementia. It also poses a major challenge to the researchers who are working to come up with effective treatments for the disease, which afflicts some 5 million Americans.

But now artificial intelligence is learning to do what doctors can’t.

Separate teams of scientists at the University of Bari in Italy and McGill University in Canada have created artificial intelligence algorithms that can look at brain scans of people who are exhibiting memory loss and tell who will go on to develop full-blown Alzheimer’s disease and who won’t.

“The technology we developed will accelerate the discovery of therapies for [Alzheimer’s disease],” lead study author Sulantha Sanjeewa Mathotaarachchi, a software developer at McGill’s Translational Neuroimaging Lab, told NBC News MACH in an email. That’s because AI can help scientists identify participants for drug or lifestyle interventions at the earliest stages of dementia.

At McGill, the researchers fed an algorithm 191 PET scans of the brains of patients experiencing a decline in memory and thinking abilities, a condition called mild cognitive impairment. The researchers taught the algorithm which of these people had gone on to develop Alzheimer’s and which had not. The key to telling the two groups apart is a protein called amyloid, which shows up in the brains of people with Alzheimer’s and those with mild cognitive impairment.

“To the naked eye of the physicians, amyloid images show a widespread distribution through the entire brain,” Mathotaarachchi wrote.

The difference in amyloid between the two groups is too subtle for humans to detect, but the AI system, called AIDDementia (short for Artificial Intelligence for Diagnosing Dementia), had no problem. When it analyzed a new set of 82 brain scans, it identified who would develop Alzheimer’s in the next two years with 84 percent accuracy.

Meanwhile, the University of Bari team employed a similar approach, training a system with MRI brain scans. Their algorithm uses patterns in brain cell connections to identify who will develop Alzheimer’s within the next decade.

Mathotaarachchi says the AI system will need to be improved before it is made available for use by doctors. He hopes to boost its predictive ability by training it to make use of other forms of brain imaging, including MRI scans. The system must also be trained with more diverse patient populations, so that it can learn to tell the difference not just between different types of dementia but also between dementia and other brain problems, such as stroke.

Preparing to make a positive transition to a Care Center

Change is challenging for anyone, but as seniors age, change may feel even more threatening and cause more stress. When it comes time to talk about moving into a long-term care community, many seniors are reluctant. Whether your loved one is fearful of change and loss of independence or is unwilling to move, there are some things you can do to help them make a positive transition to long-term care before, during and after the move.

“Seniors become attached to the places they have lived and the people they have spent most of their time around,” says Peggy. “They cling to possessions, comfort, and everything that is familiar, and when it becomes time to move to long-term care, leaving that all behind can be very emotional.”

Families are also impacted with moving their loved one into a long-term care community. They may feel guilty about not being able to care for their loved one as well as they should or may be afraid their loved one will not adapt well to community life. Families may also be unsure if they are making the right decision; however, with time and patience, both you and your loved one may find that making the move was one of the best things you could have done for all involved.


If you and your loved one are just in the beginning stages of planning for long-term care, it can seem overwhelming. In order to help make the future transition easier for both of you, plan as far ahead as you can. It can help to think about:

  • When you should begin the conversation. Try to have the conversation about long-term care as soon as possible. This can help your loved one to open up to the idea and not feel pressured or bombarded. This may be a conversation that you will have more than once, as your loved one may not want to talk about it at first.

  • What your loved one may be feeling. Be understanding when your loved one doesn’t want to consider transitioning to long-term care. Consider how you would feel and try to put yourself in their shoes. Try to approach the subject with compassion.

  • Where your loved one may fit the best. Tour a few long-term care communities with your loved one in order to gauge their interest and find one that they truly like. This can help them to make the transition with a more positive mindset.

  • How much long-term care will cost. Be sure to consider all options and ask how much long-term care is going to cost. You will want to be sure your loved one can afford the community they love. For help finding ways to pay for long-term care, read our blog.


Once your loved one finds a long-term care community that they love, it’s important to make the transition to the community as easy as possible. In order to make this a positive experience, keep the following in mind:

  • They may want to make their room look familiar. In order to make your loved one’s transition easier, try to bring as many items from home as you can or make an effort to make their new room look like home. Some tips for making long-term care feel like home can be found on our blog.

  • Helping them move may make them more comfortable. The day your loved one moves into their long-term care community can be scary and stressful for anyone, but for your loved one it can take even more of an emotional toll. Be there to help them transition and get settled in. Reassure them that everything will be okay and that you are there for them.

  • Your loved one may not jump right into their new lifestyle. It make take some time for your loved one to get comfortable enough to join programs and activities. Don’t push them into it, but try to encourage them to join a club if there’s something particular they might like.

  • It might take time for them to make friends. At first, your loved one may not be extremely social and could be shy. If they are outgoing, making friends can be easy, but if not, it may take some time. Once they join some programs, meet others with the same interests or become more acquainted with the community, it will become easier.


Once your loved one has moved into their long-term care community, you may think the transition is complete, but it may take a little more time to get your loved one fully comfortable and acquainted with their new community. It’s important to keep in touch with your loved one and their care team in order to ensure they are happy and comfortable.

  • Keep in touch with your loved one. After they move, make an effort to visit and check in with them. Ask them how they are doing, if they are getting involved with programs and if they are making any friends.

  • Talk to their care team. Your loved one’s long-term care team can provide insight into how your loved one is feeling and if they are adapting well. They will be there to support you and your loved one in making this transition as positive and easy as possible.

  • Send them little gifts. Let your loved one know you are thinking of them by visiting or sending little gifts. Cards, little presents and unexpected visits can help your loved one to know you care and can boost their mood in the beginning of their new journey.

Ensuring Medication Safety

Today’s Caregiving – 

People over the age of 65 represent 14% of the US population but consume more than one-third of prescription medications. The average senior citizen uses more than five different medications each day. This does not count nonprescription, over-the-counter drugs. As many as 90% of seniors also use herbal remedies and vitamins. While there is risk associated with each type of medication – including side effects, allergic reactions or interactions with food, alcohol or other drugs – the risk is magnified in seniors as they are typically more sensitive to these effects.

Practitioners and educators in clinical pharmacology and internal medicines, maintain that it is imperative that caregivers educate themselves about the proper use of medications:

From avoiding the risk of interactions to understanding and following instructions for storage and dosing. The following suggestions may help to ensure safe and effective use of medications:

  1. Be familiar with the dosage instructions – including whether a drug should be taken with food, with milk or other fluids or on an empty stomach. Not following the dosage instructions can result in a medication being less effective or causing complications. It is also important to note that in most medicines recommended dosages are determined using trials with a younger population. In many instances, seniors may require a different dosage.
  2. Familiarize yourself with circumstances under which the medicine should not be taken – including a history of allergic reactions, existing conditions, etc. This is particularly true for the elderly who generally have a number of medical conditions which younger adults do not have.
  3. Understand the storage instructions and follow them. Because of moisture and heat, it is sometimes best not to store medicines in the bathroom.
  4. Be aware that there may be warnings to avoid heat, cold or sun when taking a medication. Some medications may cause great sensitivity to sunlight resulting in severe sunburn or skin eruptions which can be dangerous. In addition, it may be necessary to avoid excessive heat or cold when taking certain prescription medications. In such cases, saunas, whirlpools and even exercise in the heat of the day should be greatly limited or avoided completely. It should be noted that seniors are particularly vulnerable to extremes of heat and cold.
  5. Be aware of instructions about avoiding particular foods and/or alcohol. Particular foods and beverages may be off-limits when taking certain medications. Grapefruit juice, a favorite among seniors, for instance, can interact with a number of medications and render them ineffective. It is equally important to find out if dietary supplements may be required when taking a particular drug. Some medications may deplete the body of nutrients. Consequently, a patient”s diet may need to be adjusted accordingly.
  6. Understand what possible side effects may occur and watch for them. Be particularly mindful of reactions or symptoms that should be reported to a doctor immediately. It is important to note that medicines often affect senior citizens differently than younger adults. What may be an innocuous reaction in a younger person may, in fact, be much more serious for a senior. Be vigilant about educating yourself on possible drug-related reactions and be especially vigilant about knowing which may require immediate medical attention.
  7. Be certain to learn whether there are specific over-the-counter medications that should be used with caution or avoided altogether when taken along with prescription drugs. Too often, many may assume that over-the-counter medications are “safe” simply because they are widely available and accessible. It is not always recognized that some over-the-counter drugs may actually weaken and impede a particular prescription drug’s effectiveness. Common antacids, for example, have the potential to minimize the effectiveness of a number of important drugs – in particular, certain antibiotics – and the combination should be either avoided or taken only after consultation with the treating physician or a pharmacist.
  8. Understand the risk associated with taking any herbal supplements in conjunction with medications. Similar to over-the-counter medications, many assume that herbals are completely “safe”. Using herbs to treat specific medical conditions has become increasingly widespread in the not-so-distant past. Unfortunately, many physicians and pharmacists are unaware of interactions or complications that herbals can cause. Interactions with herbals can reduce the effectiveness of medications in a number of cases, but in some instances, herbals can actually increase the toxicity of a medication. Consequently, it is imperative to proceed with extreme caution and be educated about the potential for problems.
  9. Familiarize yourself with what to do in the event of a missed dose. There are instances where simply taking the medication at the next opportunity is not recommended. Doubling of the dose to make up for a missed dose could be very dangerous. Such problems are compounded for seniors who are taking several different drugs during the day at different dosing schedules. The best way to avoid these problems: keep a diary.
  10. Learn how to discontinue the use of a drug. In some instances, stopping the dosage abruptly can have severe consequences, particularly when they are used daily over a long period of time.