Long Term Care

By: Robert Moore, Thursday, July 14th, 2022

Legal Groundwork

 

As discussed in prior posts, Long Term Care (LTC) costs are a financial threat to many farms.  On average, each person can expect to spend around $100,000 on LTC during their lifetime.  Some people will be lucky and never spend one dollar on LTC while others will require many years of expensive nursing home care.  This great difference in potential LTC needs and costs are one of the reasons LTC planning is so difficult.  We can never be sure what the actual LTC costs will be.

The best we can do is assess the risk to each farm on a case-by-case basis.  The assessment asks: What is each farm’s ability to absorb the average LTC costs and absorb an outlier scenario of several years in a nursing home?  When we know what the actual risk is to that specific farm, we can make better informed decisions as to the best LTC management strategy to implement.

The risk analysis looks at the potential costs of LTC and the ability of the farm to pay for those costs.  Paying LTC costs is a function of available income and assets that can be liquidated to pay for LTC costs not covered by income.  Generally, the assumption is that farmers will first use savings to pay LTC costs not covered by income, then non-real estate farm assets and then lastly real estate.  That is, the land is the last asset that a farmer will typically spend to pay for LTC costs.

To start the assessment, a realistic forecast should be made regarding available income.  It is important to keep in mind that if someone is receiving LTC, there is a good chance they will not be able to operate a farm.  So, income should probably be based more on potential retirement income than income from an operating farm or wages.  All available sources of income should be included such as retirement accounts, investments, land rents, and the sale of operating assets. The income forecast needs to be based on after-tax income. 

The income forecast is then compared to potential LTC costs.  The easiest, and most conservative comparison is between income and nursing home costs.  The most expensive type of LTC is a nursing home, so using nursing home costs is a worst-case scenario.  The first question becomes: is income adequate to cover potential LTC costs?

If there is adequate income to pay for LTC costs, other assets are not at risk.  Additionally, no further LTC planning likely needs done.  Assets are only at risk to LTC when income is inadequate to cover the costs.

For many farms, income alone will not pay for LTC costs.  In these situations, the next step is to determine how long savings will cover the deficiency.  By dividing the available savings by the income deficiency, we can determine how many years of LTC will be covered by savings.  If the savings will cover average LTC costs and outlier scenarios, then all remaining assets are likely protected.

Consider the following example.  Joe is unmarried and a farmer.  He forecasts his retirement income to be $50,000 after taxes.  He has $500,000 in savings and investments, $500,000 in machinery and equipment and $2,000,0000 in land.  He assumes that a nursing home will cost $100,000/year.  His income is $50,000 short of covering the nursing home bill.  He will need to use his savings to cover the deficiency.  He can pay for ten years of nursing home costs before his savings is depleted.

The average male will require about 2.2 years of LTC.  Joe can pay for almost five times the average stay by using income and savings.  Joe’s risk analysis shows that if he is willing to use his savings, his farm assets are at low risk of being consumed for LTC costs.  It is unlikely that Joe will need more than ten years of LTC.

Many farms do not have much savings or investments as all the money goes back into the farm.  In these situations, operating assets may need to be liquidated to pay for LTC.  Like the income forecast, available operating assets should be valued as after-tax.

Consider the same example as above but Joe only has $50,000 in savings.  In this scenario, his savings will only pay for one year of LTC.  After that, he would need to sell machinery to help pay for his care.  The machinery will pay for ten years of care.  In this risk analysis, Joe’s savings and machinery are at risk to LTC costs.  However, his land is likely safe unless Joe requires more than ten years of nursing home care, which is unlikely. 

In this situation, Joe may decide that he is not willing to risk his machinery and transfers it to an irrevocable trust or implements some other strategy to protect it from LTC costs.  If he protects his machinery, he will also need to do the same for his land.

If income, savings and operating assets are insufficient to cover LTC costs, then land is at risk.  As stated above, this is almost always the asset most important to farmers and the asset requiring the most protection.  If the risk analysis shows that the land is likely at risk to LTC costs, farmers will often take action to protect the land.  Protecting the land may include gifting to heirs or transferring to an irrevocable trust.

Using the same example again, except Joe quit farming several years ago and does not own any machinery.  Using his savings, he can only pay for one year of LTC before his land is at risk.  Joe decides to gift his land to his children to avoid having to spend it down for LTC.  Joe decided upon an aggressive LTC plan due to his land being exposed to significant risk from LTC.

It should be noted that gifting assets or transferring assets to an irrevocable trust has many LTC implications and tax implications.  For example, gifting away assets can cause Medicaid ineligibility for up to five years and can have negative tax implications for heirs.  Considerable thought and analysis should be undertaken before gifting assets or transferring to an irrevocable trust.  Remember that there are disadvantages to gifting assets or transferring to an irrevocable trust.

The examples above use a relatively simple scenario using a single person to explain the concept of risk assessment.  For married couples, the assessment is more complicated because we now have the possibility of two people having LTC costs.  Additionally, not all income can be allocated to LTC if one spouse remains at home with continuing living needs.  

As the above discussion shows, until a risk assessment is performed, it is difficult to know what strategy to implement.  When income and/or savings is adequate to cover many years of LTC, there may not be a need for aggressive LTC planning.  If income and savings will only cover LTC for a short period of time, aggressive planning may be needed to protect assets.

An attorney familiar with LTC issues can be helpful with the risk assessment.  Before transferring assets or implementing the plan, an attorney should be consulted.  LTC planning can be complicated and technical.  Implementing the wrong plan can make things even worse.  A small investment in legal fees is worthwhile to be sure your LTC plan is the correct plan for your farm.

Posted In: Estate and Transition Planning
Tags: Long Term Care
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Long term care written out in a blue bubble with associated activities in surrounding/connecting bubbles.

By Robert Moore, Attorney and Research Specialist, OSU Agricultural and Resource Law Program 

The costs for assisted living and nursing home care have steadily been increasing.  Many people find themselves in the situation where their income will not cover the costs of long-term care.  Long-term care costs have become a significant risk to Ohio farms and the ability to continue a viable farming operation for future generations.

The following are the most recent long-term care costs from a Genworth survey:

Type of Care                                                     Annual Cost

Ohio Semi - Private Room                                  $85,776

Ohio - Private Room                                          $98,556

National – Semi-Private Room                           $93,075

National – Private Room                                    $105,850

Ohio - Assisted Living                                        $52,500

National - Assisted Living                                   $54,000

Ohio costs are less than national costs but are still significant.  Care facilities in small towns and rural areas tend to cost less than facilities in larger cities like Cleveland, Columbus and Cincinnati.  Costs are expected to continue to increase.  By 2030, Genworth predicts that national average cost for a private room in a nursing home will be around $142,000/year.

Farmers that do not have adequate income to pay for long-term care costs will be required to dip into savings to make up the deficit.  If savings are extinguished, farm assets may need to be sold to pay for the care.  The sale of these farm assets is what can jeopardize the future viability of the farming operation.

There are no easy solutions regarding long-term care costs.  Options include gifting assets away, buying long-term care insurance or self-insuring.  Medicaid can also play a role in long-term care costs.  In future posts we will discuss strategies to minimize the risk of long-term care costs to farming operations.

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