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Dear Jill: I am 85 years old. I am married and have no children. What are my options for end-of-life care?

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Thank you, Margret

Dear Margret:

When considering end-of-life options for our clients, a number of factors must be considered. It is critical that you receive the right care at the right time. Failure to obtain needed services may cause you and your husband to rapidly decline by experiencing preventable medical incidents, such as falls.

Some long-term care insurance companies will write long-term care policies up to age 85, so you may only have a small window to obtain insurance that may enable you to get care in your desired setting.

Before knowing whether long-term care insurance is advisable in your situation, we would need to know your health situation and your financial situation. Either one of these situations may make this option not viable to you. We believe that it is important for you to have an advocate that does not sell insurance helping you decide whether long-term care insurance is a viable option. We strongly advise at least considering the option as most of the people that we encounter would prefer to have care provided at home rather than in facilities and this provides a funding mechanism to make that happen.

In analyzing your options for long-term care, we would consider disease trajectories for any illnesses that you and your husband may have. In other words, we would need to determine for how long we are likely to need to plan and the probable extent of medical care necessary. If you and your husband currently have un-reimbursed medical expenses and if either of you served in the military during a war time, you may be able be eligible for a pension from Veterans Affairs to help pay for these un-reimbursed medical expenses.

Oftentimes, we find that our clients are not receiving the care that they need, because financial concerns inhibit their use of services. Home care or assisted living may be warranted and this benefit may assist in paying for it. There are income and asset limitations to qualifying, however, if care is warranted, planning is usually possible to obtain the benefit. Appropriate planning should be done prior to an application so that you can make maximum use of the VA pension rules.

If either of your conditions warrant nursing home care either now or in the future, Medicaid may be necessary in order to pay for the care of the spouse in the nursing home without impoverishing the spouse still living in the community. Planning options also exist for this type of care. The Medicaid rules are different from the VA rules so a cohesive plan must be developed to utilize both types of benefits when veterans are clients.

You have asked about “end-of-life” care. If you are actually in the probable last six months of life, then Hospice care may be warranted. Hospice can provide services to dying patient and to family members. Collier County now has two hospice providers.

Life Care Planning Law Firms help to evaluate these situations by taking an holistic approach. A nurse advocate helps the firm determine what type of care the client needs and provides medical advocacy for that care. The lawyers prepare a financial plan to utilize available resources, insurance and government benefits to help pay for the care. The lawyers also make sure that appropriate legal documents are in place to provide for accessibility to assets and funding. The benefits coordinator in the firm works with the client with insurance and applications.

While these situations can appear daunting, piece of mind is possible with appropriate planning and knowledgeable advice.