When To Start Planning for ALTCS?

Our latest Arizona Republic article in the weekly Aging and the Law column can be found below. Our column runs every Friday in select Arizona cities.
Q: A couple of weeks ago, my father suffered a fairly severe stroke.  After a brief hospitalization, he was transferred to a skilled nursing facility for rehabilitation.  He is making strides in his therapy, but we don’t know if he will fully recover.  Without this knowledge, how can I determine when to prepare for the ALTCS program?
I am assuming that your father’s care is currently covered by Medicare.  By design, however, Medicare covers only acute care, or that care which is rehabilitative in nature.  For as long as your father is showing marked improvements, then, his Medicare coverage could remain in effect for up to 100 days.  More specifically, Medicare could cover the first 20 days without co-payment, and days 21-100 for a co-payment of just over $150 per day.  Importantly, once it is determined that your father’s health has plateaued, and that he has transitioned from acute care into long-term care, Medicare coverage will end.
Once Medicare coverage ends, your father will have a few options.  If he is well enough, he can return home and resume his previous way of life.  If his health has not returned by this point in time, however, he will have to pay privately or seek an alternative payer source.  If your father has substantial long-term care insurance, then this could provide a solution, but without such coverage, ALTCS might be his only viable option.
Given the huge expenses associated with long-term care, it makes most sense to hope for the best, but plan for the worst.  By this, I am suggesting that the time to begin considering the ALTCS program for your father is now.  Each application process is fact-dependent, but it can sometimes take several months or more to gain access to the benefit, so planning while Medicare is still in effect can be very advantageous.
Aging and the Law is authored by the attorneys at JacksonWhite and addresses legal issues that arise for the elderly and their families.  Questions can be sent to firm@jacksonwhitelaw.com.
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