Long Term Care (LTC)
Planned down-sizing when you are reasonably healthy and mentally alert is different from the necessity to move due to disability, incapacity, or severe illness, to an Adult Family Home, Assisted Living Facility, a Skilled Nursing Home (SNF), or a Memory Care Facility for long term care depending upon the extent of care required. These facilities now (year 2014) cost about $4,000 to $9,000 per month or more.
Medicare covers only a specified number of days in a SNF if discharged from a hospital after being an “inpatient” (which is different from being admitted for “observation”) for three days. Due to the cost involved, one may wish to buy Long Term Care (LTC) coverage from an insurance company. The older you are, the higher the premium. In order to be considered eligible for benefits under these policies, generally you must be unable to perform certain number of the Activities of Daily Living (ADL) such as dressing, eating etc. These coverages are usually for a specific number of years for a specified dollar amount per day. There may be also an elimination period that specifies an initial number of days the benefits may not be payable. The terms of the insurance and the financial viability of the insurance companies should be carefully evaluated before purchasing an LTC insurance.
If you need LTC, you may qualify for Medicaid assistance, if your income (not including the spouse’s) and your resources (assets) including the spouse’s (but excluding your home and one vehicle) are less than specified amounts. Such assistance is available when you are medically needy whether you are in a health care facility or at home. The basic rules are reasonably well explained at the "Questions and Answers" websites listed below. If your resources are somewhat more than the limit, you should consult an Elder Law attorney to explore if you can rearrange your assets with your spouse to qualify for Medicaid.
Some of the books on the status of LTC in the USA and what to expect are listed here.